The Care Quality Commission (CQC): Early years

The Health and Social Care Act 2008491 (HSCA), Section 1(1) of which

created the Care Quality Commission as a ‘body corporate’, and Section 1(2) of which abolished the regulators which it replaced, namely the Commission for Healthcare Audit and Inspection (formerly the Commission for Healthcare Improvement), the Commission for Social Care Inspection and the Mental Health Act Commission.

The legal entity possessed by the CQC was a corporate body without Crown status, compared, for example, with regulators such as the Food Standards Agency (FSA) and the Health and Safety Executive (HSE) both of which are non-ministerial government departments, the latter containing a notably tripartite membership structure comprised of government officials, persons from the employer side of industry and trade union officials.

That the CQC does not replicate the earlier regulatory templates and is an entirely new brand of governance, but nevertheless it has Department of Health ministerial and civil service structural support, and ultimately direct Parliamentary accountability.

491

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The HSCA and subsequent statutory remit to the CQC is still expanding in transitional terms. This is likely to continue to be a feature of the new body for some time as it copes with new challenges in its role and functions. It currently regulates all NHS Trusts,492 adult social care providers including day care services and home

care services, independent health care providers, including private hospitals, independent ambulance services, hospices and private doctors and dentists. Since April 2013 the CQC has been expanded to cover all GP practices, and the Health Secretary has made it clear that there are plans to expand its remit even further and develop links with other providers of healthcare services.493

This intention is commented upon by the Comptroller and Auditor- General,494 who states that “proposals to extend the Commission’s role risk

distracting the Commission from its core work of regulating health and social care.”495 The role of the CQC is detailed in the background and summary of the

Health and Social Care Act 2008:

“Chapter 1 part 1 of the Act establishes a new body called the Care Quality Commission (“the Commission”). The Commission will be responsible for the registration, review and inspection of certain health and social services in England (but not any care services that are regulated by the Chief Inspector of Education, Children’s Services and Skills (‘CIECSS)). It will replace CHAI

492 _{Its predecessor statute, the Care Standards Act 2000 (2000, c.14), had regulated providers of adult social}

care and independent healthcare, so the HSCA 2008 remit is much wider.

493

www.dh.gov.uk.

494 _{An officer of the House of Commons by status – National Audit Act 1983 (1983, c.44) – Section 1(3).} 495

Executive summary (penultimate paragraph) – NAO Report 2 December 2011, Ibid. Apparently successful in terms of not taking over the Human Tissue Authority (HTA), further mentioned below.

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and CSCI. The functions currently performed by MHAC will be transferred to the Commissions and the Welsh Ministers.”496

“Chapter 2 of Part 1 creates a system of registration for providers and, in some cases, managers of health and adult social care…All providers, including NHS providers, will be brought within the ambit of registration…Once a provider or manager has been registered, the Commission will be responsible for checking continued compliance…and will have a range of sanctions…The Commission will have a wider range of powers to suspend registration”497

“Chapter 3 of Part 1 requires the Commission to carry out periodic reviews of care provided by or commissioned by Primary Care Trusts (‘PCTs’) or English local authorities to see how well the bodies reviewed are doing. It also requires the Commission to review health care provided by PCTs, English NHS Trusts and NHS Foundation Trusts.”498

Powers of the Care Quality Commission (CQC) as a regulator499 broadly embrace

inspection, monitoring, guidance and intervention in improvement notice and prosecution terms with care homes, hospitals, ambulances, care services in peoples own homes, doctors and G.P’s activities, dentists, clinics, community services and mental health services The Care Act 2014 is adding to these powers of market oversight to guard against provider failure in April 2015.

496

Health and Social Care Act 2008, Background and Summary: Part 1 – The Care Quality Commission, p.1 Section 9.

497_{Ibid, p.1 Section 10.} 498

Ibid, pp.1-2, Section 11.

499

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The CQC’s role and emerging responsibilities is indicative of how much complexity and technical skill is required to be a regulator of health care. 500 The

CQC is subject to audit by the National Audit Office501and its annual reports are

subject to ‘Annual accountability hearing with the Care Quality Commission’ by the House of Commons Health Committee.502 Early criticism of registration of providers

was noted by the Committee who concluded that “It is regrettable that this was neither foreseen nor addressed before the vast majority of providers had already fought through the process.”503 In the case of dentists it was noted that “...It is

astonishing that it could ever have been considered sensible for small dental practices to work through the same process as a large hospital.”504

It was clear that the CQC struggled to cope with its new and role and function during the transitional period to it being set up and established.