Thursday 18 October 2018
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CQC - busy doing nothing at great expense

Or at least busy doing nothing that helps patients and users of social care services.

As the trickle of criticism of CQC has turned into turned into a torrent, the quango charged with checking that health and social care is good enough spends much of its time and resources defending its mistakes instead of getting on with its job.

And as the CQC hierarchy is asked to account for themselves by various parliamentary committees, the Department of Health, the Audit Commission, and the Mid-Staffs hospital inquiry, I wonder if they understand that this totally unproductive process is exactly paralleled by their own treatment of care homes. Care home managers spend a disproportionate amount of time attempting to satisfy CQC’s insatiable demand for “evidence” of compliance rather than on their core task which is managing the care home for the residents.

Before she was appointed as CQC’s chief executive, Cynthia Bower was the head of the West Midlands Strategic Health Authority and Mid Staffs Hospital (previously Stafford General Hospital) was one of her responsibilities. Understandably, Bower has been called to give evidence at the public inquiry which is being held to investigate the management and regulatory failings that allowed inhumane and degrading treatment and up to 1200 unnecessary deaths. She has been called both as one of the managers responsible and as one of the regulators responsible.

Many people, including Andrew Lansley, have questioned how it was that, with such a questionable management record and failure to confront extreme bad practice, Bower was chosen to head CQC, be paid £200k a year and bump up her already massive pension pot to £1.5 m.

In her three years heading CQC, Bower has run to form. She has got rid of the investigations team (from the Healthcare Commission) that exposed the disastrous failings of Mid Staffs. Having cut inspections dramatically, she now proposes to re-instate them and is asking for more money to do so. She has set up extremely expensive systems for computing risk and compliance profiles and found that they are no substitute for on-the-ground inspection. Without regular inspection, her organisation has missed or ignored countless serious failings in care. She has claimed (in the CQC annual report) to have completed more than twice as many inspections as actually took place. By failing to recruit she has allowed her essential workforce of inspectors to dwindle while underspending by £10m, raising fees to care homes and claiming that she needs more taxpayers’ money for more inspectors. Oh, and she’s completed the entirely unnecessary task of registering thousands of care providers which were already perfectly adequately registered under the previous regime. And while CQC has been busy doing nothing useful, she has compelled hard pressed care home managers to provide endless information and evidence of compliance for her useless (and expensive) regulatory system, and thereby diverting them from their core task.

Of course, Cynthia Bower has not been busy doing nothing all on her own. She has many other senior colleagues and for its first two years CQC relied on the connivance, if not full support, of most of the health and social care establishment. Government - even Lansley - still makes a show of supporting CQC. CQC is consulting - yet again - on its proposals for change, and has, at last, arranged to meet with the Association of Care Managers, one of its most enduring and consistent critics, and we will put forward our proposals on the reform of CQC (see below).

Nor can it be claimed that Cynthia Bower was solely responsible for the failure at Mid Staffs, but as the chief executive of the Strategic Health Authority and a strong advocate of the hospital going for Foundation Trust status when those failings in care were at their most extreme, there is clear accountability. If Mid Staffs had not failed so dreadfully, there would be no public inquiry at a cost of more than £10m so far. And if there was no public inquiry, Cynthia Bower (and other senior CQC staff) would not have had to give evidence to it.

The Association of Care Managers has now twice attempted to ascertain the cost in time and money to CQC of staff giving evidence to the inquiry. At the first attempt, CQC managed to provide only the travel expenses (“2nd class” they proudly claimed!). In spite of including in the Freedom of Information request the wording that “Overall, I am trying to establish the whole extent and cost of CQC resources that have been used in giving evidence to the inquiry”, the reply was that they didn’t know how much time and money had been expended on an individual basis.

At the second attempt, CQC revealed the following:
The legal fees in relation to the Inquiry are £1,246,616
The costs of CQC staff attendance at the Inquiry are £43,721.30
However, CQC doesn’t record and was not able to estimate the time (or cost) spent by senior staff on preparing for and compiling evidence for the inquiry. Given that some of the evidence runs into hundreds of pages, that the legal fees represent a good deal of time spent with CQC staff, and that senior managers are paid at an equivalent rate to lawyers, it might not be wide of the mark to guess that the cost of preparation for the inquiry might be somewhere around £1m.

So, we know that the Mid Staffs Inquiry has cost CQC a lot more than the £1.5m that they have so far admitted, and perhaps as much as £2.5m.

This startling figure raises many questions. Do these private law firms just bill CQC for so many hours? When paying the bill, does CQC check that it’s accurate, and how would they do that if they don’t know who was using this legal advice and when? When setting up CQC and appointing staff, there was no expectation that senior managers would have to prepare for and attend the inquiry; so, what work were they expecting to do during the time that they have given to the inquiry? Don’t senior managers plan, allocate, and keep a record of the work they do, and review the proportion of time they spend on various duties? What view do the Commissioners (who have ultimate responsibility for CQC) take of their chief executive and senior management taking time out for the inquiry when CQC is under such immense pressure to improve its performance?

If a care home manager performed in the same way as the Chief Executive of CQC, CQC inspectors - we hope - would have questions about the management of staff, time and money, and might suggest that the manager concentrated on the task in hand before the care turned to neglect, and residents suffered as the patients of Mid Staffs Foundation Trust have suffered . . . and died.

Let’s dismantle this absurd edifice and get back to square one: a clear, plain process of inspection in which inspectors check that care homes are providing good enough care.

The Association of Care Managers calls for a new approach to regulation and inspection of adult social care:
Prioritise the quality of care and the rights and safety of the people who use the services – this is the primary purpose of inspection
Inspect services as often as necessary but at least once a year
Inspectors should aim to prevent bad practice rather than to condemn it after it has occurred and after residents have suffered
Inspectors should be locally based and known – and accessible - to the public and users of the services
Inspection reports should be written for the public
Inspectors should work directly with residents and relatives, staff and managers of individual homes, NOT with the provider groups and organisations
Inspectors should respond to and investigate complaints, and be willing and available to visit the service without notice and at any time
Inspectors should understand how the services work and be willing and able (when appropriate) to help services to improve
People who use services should have a formal and influential voice in the assessment of care.

We believe all of this can be achieved with lower inspection fees. However, it will mean a total reorganisation of the CQC, dismantling the centralised bureaucracy and grandiose management structure, and setting up local Healthwatch inspection teams employing independent inspectors who will be judged by - and paid by - results.

ACM supports the effective inspection of care services, concentrating on the rights, safety and wellbeing of those who use the services.

John Burton, Head of the Association of Care Managers
November 2011