Care Quality Commission
Encyclopedia
The Care Quality Commission is a non-departmental public body
of the United Kingdom government established in 2009 to regulate and inspect health and social care services in England. This includes services provided by the NHS
, local authorities, private companies and voluntary organisations - whether in hospitals, care homes or people's own homes. Part of the Commission's remit is protecting the interests of people whose rights have been restricted under the Mental Health Act
. In early 2011 it was revealed by the BBC that the Commission had failed in its duties, since it had proved to be incapable of confronting abuse in residential care homes, and specifically the Winterbourne View residential hospital in Bristol
, even when that abuse had been reported to it by a whistleblower.
and the Commission for Social Care Inspection
. The Mental Health Act Commission
had monitoring functions with regard to the operation of the Mental Health Act 1983
.
The Health and Social Care Act 2008
established a single, integrated regulator for health and adult social care - the Care Quality Commission to replace these three bodies. The Commission was created in shadow form on 1 October 2008 and began operating on 1 April 2009.
and ensuring that regulation and inspection activity across health and adult social care is coordinated and managed.
The new system will enable a joined-up regulation for health and social care, helping to ensure better outcomes for the people who use services. There are already many good examples of integrated health and social care delivery so the creation of a single regulatory system will fit with this.
Health and social care providers - including, for the first time, NHS
providers - will be required to register with the new regulator in order to provide services (see below). The registration requirements that all providers must meet will be consistent across both health and adult social care and will be the subject of a forthcoming consultation. Focussing regulation on the levels of safety and quality that those who use services care most about will help ensure that patients, users and vulnerable groups are protected.
For staff working in provider organisations, the new regulatory system will provide a much clearer system of exactly which requirements they must meet in order to provide services. The risk-based approach means that regulation activity will be targeted where action is required.
The Act gives the Commission a wider range of enforcement powers along with flexibility on how, and when to use them. This will allow the regulator greater powers to achieve compliance with registration requirements - including requirements relating to infection control. The Commission will be able to apply specific conditions to respond to specific risks - such as requiring a ward or service to be closed until safety requirements met, as well as being able to suspend or de-register services where absolutely necessary.
Bringing the functions of the Mental Health Act Commission into the remit of the Care Quality Commission will strengthen the monitoring of the Mental Health Act, and offer increased oversight of the treatment of patients subject to compulsory detention.
In October 2010 the coalition government announced swingeing cuts to the world of quangos and ALBs. However, the Care Quality Commission was not only spared but has had its powers increased.
are required to register with the Care Quality Commission. In order to be granted registration, care providers need to demonstrate that they can meet, or are already meeting, the registration requirements. To maintain their registration they need to demonstrate an ongoing ability to meet the requirements.
A registration system for social care and independent health providers already exists under the Care Standards Act 2000
, but there is no such system for the NHS. The new registration system will incorporate providers from all sectors into a single system. (For NHS trusts, the registration criteria will thus replace Standards for Better Health
.) In developing the new registration system and its requirements both the Government
and the Care Quality Commission will build on the experience of the current commissions and service providers in operating under the existing system and against the current standards.
The Department of Health
ran a consultation on which health and adult social care services should require registration with the Care Quality Commission; and what the requirements for registration should be. The consultation closed on 17 June 2008.
In 2010 the Care Quality Commission required that all care providers re-registered their services - an unpopular move with many care providers who saw their current inspection rating as being under threat - and the regulator is expected to report back in April 2011 on a new system of regulation.
announced that Barbara Young, Baroness Young of Old Scone
, had been appointed as shadow Chair of the Care Quality Commission. The announcement followed an independent recruitment exercise conducted by the Appointments Commission and a pre-appointment scrutiny hearing by the Health Select Committee, which subsequently endorsed Barbara Young for appointment. Baroness Young was formerly the Chief Executive of the Environment Agency
.
The most recent staff survey completed identified that 86% of the staff have no confidence in the executive team. 82% of the staff team identified that it is not safe to speak up and challenge the way things are done.
On 26 Dec 2009, Barbara Young announced that she is stepping down from the role, effective February 2010 . Dame Jo Williams (Deputy Chairman of the CQC) will act as Chairman until a successor is appointed.
On 1 October 2010 Dame Jo Williams was confirmed as the Chair of CQC
. Prior to this, she held posts as chief executive of a community health trust and a primary care trust. In addition, she has had practical and managerial experience in children's services, policy development between health and social care in mental health, intermediate care for older adults and family support for children.
Bower's appointment was called into question following the publication of the report of the investigation
into Mid Staffordshire NHS Foundation Trust
by the Healthcare Commission
in March 2009. The report criticised the strategic health authority
, NHS West Midlands
, (of which Bower was chief executive from 2006 to 2008) for having "accepted without detailed scrutiny" the trust's account that it was taking effective action in response to high mortality figures. The report did also note that NHS West Midlands had commissioned the University of Birmingham
to undertake research into the mortality rate at the trust. Shortly after publication of the report the Health Service Journal noted that Bower had been criticised for not doing more to prevent the problems at Mid Staffordshire. The article also quoted Bower as saying that if the Healthcare Commission had shared its information about the trust with NHS West Midlands sooner, then the two organisations could have 'worked together to look at what the issues were'.http://www.hsj.co.uk/news/acute-care/mid-staffs-was-off-sha-radar/2007598.article The criticisms of Bower prompted the Care Quality Commission to issue a public defence of its chief executive which was also reported in the Health Service Journal
at the beginning of April.http://www.hsj.co.uk/news/acute-care/care-quality-commission-defends-cynthia-bower/5000279.article
magazine has regularly reported alleged failings in the CQC.
The BBC TV programme Panorama
broadcast evidence of mistreatment on residents of a Castlebeck hospital on May 31, 2011. Despite evidence concerning the same institution having previously been given to the Care Quality Commission, the body failed to act and has since admitted "an unforgivable error of judgment” .
It was reported in November 2011 that the Care Quality Commission was being investigated, regarding a number of alleged failures, by officials at Department of Health and NHS management.
Non-departmental public body
In the United Kingdom, a non-departmental public body —often referred to as a quango—is a classification applied by the Cabinet Office, Treasury, Scottish Government and Northern Ireland Executive to certain types of public bodies...
of the United Kingdom government established in 2009 to regulate and inspect health and social care services in England. This includes services provided by the NHS
National Health Service (England)
The National Health Service or NHS is the publicly funded healthcare system in England. It is both the largest and oldest single-payer healthcare system in the world. It is able to function in the way that it does because it is primarily funded through the general taxation system, similar to how...
, local authorities, private companies and voluntary organisations - whether in hospitals, care homes or people's own homes. Part of the Commission's remit is protecting the interests of people whose rights have been restricted under the Mental Health Act
Mental Health Act 1983
The Mental Health Act 1983 is an Act of the Parliament of the United Kingdom which applies to people in England and Wales. It covers the reception, care and treatment of mentally disordered persons, the management of their property and other related matters...
. In early 2011 it was revealed by the BBC that the Commission had failed in its duties, since it had proved to be incapable of confronting abuse in residential care homes, and specifically the Winterbourne View residential hospital in Bristol
Bristol
Bristol is a city, unitary authority area and ceremonial county in South West England, with an estimated population of 433,100 for the unitary authority in 2009, and a surrounding Larger Urban Zone with an estimated 1,070,000 residents in 2007...
, even when that abuse had been reported to it by a whistleblower.
History
Until 31 March 2009, regulation of health and adult social care in England was carried out by the Healthcare CommissionHealthcare Commission
The Healthcare Commission was a non-departmental public body sponsored by the Department of Health of the United Kingdom. It was set up to promote and drive improvement in the quality of health care and public health in England and Wales...
and the Commission for Social Care Inspection
Commission for Social Care Inspection
The Commission for Social Care Inspection was a non-departmental public body and the single, independent inspectorate for social care in England. Its sponsor department was the Department of Health of the United Kingdom...
. The Mental Health Act Commission
Mental Health Act Commission
The Mental Health Act Commission was an NHS special health authority that provided a safeguard for people detained in hospital under the powers of the Mental Health Act 1983 in England and Wales...
had monitoring functions with regard to the operation of the Mental Health Act 1983
Mental Health Act 1983
The Mental Health Act 1983 is an Act of the Parliament of the United Kingdom which applies to people in England and Wales. It covers the reception, care and treatment of mentally disordered persons, the management of their property and other related matters...
.
The Health and Social Care Act 2008
Health and Social Care Act 2008
The Health and Social Care Act 2008 is an Act of the Parliament of the United Kingdom.-Section 170 - Commencement:Orders made under section 170* * *...
established a single, integrated regulator for health and adult social care - the Care Quality Commission to replace these three bodies. The Commission was created in shadow form on 1 October 2008 and began operating on 1 April 2009.
Functions
The Act sets the new Commission's functions in assuring safety and quality, assessing the performance of commissioners and providers, monitoring the operation of the Mental Health ActMental Health Act 1983
The Mental Health Act 1983 is an Act of the Parliament of the United Kingdom which applies to people in England and Wales. It covers the reception, care and treatment of mentally disordered persons, the management of their property and other related matters...
and ensuring that regulation and inspection activity across health and adult social care is coordinated and managed.
The new system will enable a joined-up regulation for health and social care, helping to ensure better outcomes for the people who use services. There are already many good examples of integrated health and social care delivery so the creation of a single regulatory system will fit with this.
Health and social care providers - including, for the first time, NHS
National Health Service
The National Health Service is the shared name of three of the four publicly funded healthcare systems in the United Kingdom. They provide a comprehensive range of health services, the vast majority of which are free at the point of use to residents of the United Kingdom...
providers - will be required to register with the new regulator in order to provide services (see below). The registration requirements that all providers must meet will be consistent across both health and adult social care and will be the subject of a forthcoming consultation. Focussing regulation on the levels of safety and quality that those who use services care most about will help ensure that patients, users and vulnerable groups are protected.
For staff working in provider organisations, the new regulatory system will provide a much clearer system of exactly which requirements they must meet in order to provide services. The risk-based approach means that regulation activity will be targeted where action is required.
The Act gives the Commission a wider range of enforcement powers along with flexibility on how, and when to use them. This will allow the regulator greater powers to achieve compliance with registration requirements - including requirements relating to infection control. The Commission will be able to apply specific conditions to respond to specific risks - such as requiring a ward or service to be closed until safety requirements met, as well as being able to suspend or de-register services where absolutely necessary.
Bringing the functions of the Mental Health Act Commission into the remit of the Care Quality Commission will strengthen the monitoring of the Mental Health Act, and offer increased oversight of the treatment of patients subject to compulsory detention.
In October 2010 the coalition government announced swingeing cuts to the world of quangos and ALBs. However, the Care Quality Commission was not only spared but has had its powers increased.
Registration of care providers
All health and adult social care providers that come within the future scope of registrationLicensure
Licensure refers to the granting of a license, which gives a "permission to practice." Such licenses are usually issued in order to regulate some activity that is deemed to be dangerous or a threat to the person or the public or which involves a high level of specialized skill...
are required to register with the Care Quality Commission. In order to be granted registration, care providers need to demonstrate that they can meet, or are already meeting, the registration requirements. To maintain their registration they need to demonstrate an ongoing ability to meet the requirements.
A registration system for social care and independent health providers already exists under the Care Standards Act 2000
Care Standards Act 2000
Care Standards Act 2000 is an Act of the Parliament of the United Kingdom which provides for the administration of a variety of care institutions, including children's homes, independent hospitals, nursing homes and residential care homes....
, but there is no such system for the NHS. The new registration system will incorporate providers from all sectors into a single system. (For NHS trusts, the registration criteria will thus replace Standards for Better Health
Standards for Better Health
Standards for Better Health are a set of standards that the National Health Service in England must meet. The standards were set out by the Department of Health of the United Kingdom in a document of the same name published in 2004...
.) In developing the new registration system and its requirements both the Government
Government
Government refers to the legislators, administrators, and arbitrators in the administrative bureaucracy who control a state at a given time, and to the system of government by which they are organized...
and the Care Quality Commission will build on the experience of the current commissions and service providers in operating under the existing system and against the current standards.
The Department of Health
Department of Health (United Kingdom)
The Department of Health is a department of the United Kingdom government with responsibility for government policy for health and social care matters and for the National Health Service in England along with a few elements of the same matters which are not otherwise devolved to the Scottish,...
ran a consultation on which health and adult social care services should require registration with the Care Quality Commission; and what the requirements for registration should be. The consultation closed on 17 June 2008.
In 2010 the Care Quality Commission required that all care providers re-registered their services - an unpopular move with many care providers who saw their current inspection rating as being under threat - and the regulator is expected to report back in April 2011 on a new system of regulation.
Chair
On 15 May 2008, the Department of HealthDepartment of Health (United Kingdom)
The Department of Health is a department of the United Kingdom government with responsibility for government policy for health and social care matters and for the National Health Service in England along with a few elements of the same matters which are not otherwise devolved to the Scottish,...
announced that Barbara Young, Baroness Young of Old Scone
Barbara Young, Baroness Young of Old Scone
Barbara Scott Young, Baroness Young of Old Scone sits on the cross benches in the House of Lords. She was created a life peer in 1997 as Baroness Young of Old Scone, of Old Scone in Perth and Kinross....
, had been appointed as shadow Chair of the Care Quality Commission. The announcement followed an independent recruitment exercise conducted by the Appointments Commission and a pre-appointment scrutiny hearing by the Health Select Committee, which subsequently endorsed Barbara Young for appointment. Baroness Young was formerly the Chief Executive of the Environment Agency
Environment Agency
The Environment Agency is a British non-departmental public body of the Department for Environment, Food and Rural Affairs and an Assembly Government Sponsored Body of the Welsh Assembly Government that serves England and Wales.-Purpose:...
.
The most recent staff survey completed identified that 86% of the staff have no confidence in the executive team. 82% of the staff team identified that it is not safe to speak up and challenge the way things are done.
On 26 Dec 2009, Barbara Young announced that she is stepping down from the role, effective February 2010 . Dame Jo Williams (Deputy Chairman of the CQC) will act as Chairman until a successor is appointed.
On 1 October 2010 Dame Jo Williams was confirmed as the Chair of CQC
Chief executive
On 22 July 2008, it was announced that Cynthia Bower had been appointed as the Commission's Chief Executive. Cynthia Bower was previously chief executive of NHS West MidlandsNHS West Midlands
NHS West Midlands is a strategic health authority of the National Health Service in England. It operates in the West Midlands region, which is coterminous with the local government office region.-General information:...
. Prior to this, she held posts as chief executive of a community health trust and a primary care trust. In addition, she has had practical and managerial experience in children's services, policy development between health and social care in mental health, intermediate care for older adults and family support for children.
Bower's appointment was called into question following the publication of the report of the investigation
Stafford Hospital scandal
The Stafford Hospital scandal came to light because of an investigation by the Healthcare Commission into the operation of Stafford Hospital in Stafford, England. The commission was first alerted by the "apparently high mortality rates in patients admitted as emergencies"...
into Mid Staffordshire NHS Foundation Trust
Mid Staffordshire NHS Foundation Trust
The Mid Staffordshire NHS Foundation Trust is a NHS foundation trust which manages two hospitals:* Stafford Hospital - acute hospital with approximately 350 inpatient beds, opened in 1983...
by the Healthcare Commission
Healthcare Commission
The Healthcare Commission was a non-departmental public body sponsored by the Department of Health of the United Kingdom. It was set up to promote and drive improvement in the quality of health care and public health in England and Wales...
in March 2009. The report criticised the strategic health authority
NHS Strategic Health Authority
NHS strategic health authorities are part of the structure of the National Health Service in England. Each SHA is responsible for enacting the directives and implementing fiscal policy as dictated by the Department of Health at a regional level. In turn each SHA area contains various NHS trusts...
, NHS West Midlands
NHS West Midlands
NHS West Midlands is a strategic health authority of the National Health Service in England. It operates in the West Midlands region, which is coterminous with the local government office region.-General information:...
, (of which Bower was chief executive from 2006 to 2008) for having "accepted without detailed scrutiny" the trust's account that it was taking effective action in response to high mortality figures. The report did also note that NHS West Midlands had commissioned the University of Birmingham
University of Birmingham
The University of Birmingham is a British Redbrick university located in the city of Birmingham, England. It received its royal charter in 1900 as a successor to Birmingham Medical School and Mason Science College . Birmingham was the first Redbrick university to gain a charter and thus...
to undertake research into the mortality rate at the trust. Shortly after publication of the report the Health Service Journal noted that Bower had been criticised for not doing more to prevent the problems at Mid Staffordshire. The article also quoted Bower as saying that if the Healthcare Commission had shared its information about the trust with NHS West Midlands sooner, then the two organisations could have 'worked together to look at what the issues were'.http://www.hsj.co.uk/news/acute-care/mid-staffs-was-off-sha-radar/2007598.article The criticisms of Bower prompted the Care Quality Commission to issue a public defence of its chief executive which was also reported in the Health Service Journal
Health Service Journal
Health Service Journal is a weekly news print title and website on the British National Health Service, healthcare management and health policy....
at the beginning of April.http://www.hsj.co.uk/news/acute-care/care-quality-commission-defends-cynthia-bower/5000279.article
Commissioners
The first Commissioners were appointed to the board on 1 September 2008. The Commissioners currently comprise:- Professor Deirdre Kelly, Professor of Paediatric Hepatology, Birmingham Children's HospitalBirmingham Children's HospitalThe Birmingham Children's Hospital is a children's hospital located in Birmingham, England.It provides general and emergency health care services to children in Birmingham, the West Midlands and beyond. It specialises in liver transplantation, cardiac, and neonatal surgery...
- Dame Josephine WilliamsJo WilliamsDame Josephine Williams, DBE, DL was the chief executive of Mencap until 1 November 2008. She is now a Commissioner of the Care Quality Commission....
, former chief executive, MencapMencapThe Royal Mencap Society is a charity based in the UK that works with people with a learning disability.-Profile:Mencap is the UK's leading learning disability charity working with people with a learning disability and their families and carers... - Olu Olasode, Commissioner for the Commission for Social Care InspectionCommission for Social Care InspectionThe Commission for Social Care Inspection was a non-departmental public body and the single, independent inspectorate for social care in England. Its sponsor department was the Department of Health of the United Kingdom...
(CSCI) and chair of the CSCI Audit and Risk Committee - Kay Sheldon, Trustee of Mind, the national mental health charity
- Martin Marshall, Director of Clinical Quality at The Health Foundation
Criticisms
Private EyePrivate Eye
Private Eye is a fortnightly British satirical and current affairs magazine, edited by Ian Hislop.Since its first publication in 1961, Private Eye has been a prominent critic and lampooner of public figures and entities that it deemed guilty of any of the sins of incompetence, inefficiency,...
magazine has regularly reported alleged failings in the CQC.
The BBC TV programme Panorama
Panorama
A panorama is any wide-angle view or representation of a physical space, whether in painting, drawing, photography, film/video, or a three-dimensional model....
broadcast evidence of mistreatment on residents of a Castlebeck hospital on May 31, 2011. Despite evidence concerning the same institution having previously been given to the Care Quality Commission, the body failed to act and has since admitted "an unforgivable error of judgment” .
It was reported in November 2011 that the Care Quality Commission was being investigated, regarding a number of alleged failures, by officials at Department of Health and NHS management.