CQC: Care Quality Commission or Can’t Quite Cope?

Dr Philip Dobson
By Dr Philip Dobson

Dr Dobson is Medical Director of LCS Healthcare and holds board certification under RPA 2000 as a Laser Radiation Protection Adviser.

In this blog, I will discuss the need for change and a possible solution to the problems which are faced by the regulation of the health and social care industry in 2013.

The fact that the CQC is “not fit for purpose” seems finally to have begun to dawn on the government and Department of Health, following the publication of the Keogh report (which seems to have slipped into oblivion!) and the innumerable scandals in the NHS and independent social care sector over the last few months.

The attitude from the powers that be seems to be that by appointing a “Hospital Tsar” and a “Care Home Tsar” and telling the CQC to pull its finger out, all of the problems will be solved. I wonder, however, how long it will take before the government realises that what we have in healthcare is a situation akin to what was seen in the financial services industry and what we actually need is a very similar solution.

Those of us who have been around in health care regulation for a few years (10 years and over 1200 registrations in my case) have known for a long time that the regulator was unable to cope; due to a mixture of a lack of knowledge and understanding of the industry in both the top management and individual inspectors, policies which were naive to the point of stupidity and being hamstrung by inadequate powers to control a dynamic and rapidly changing industry.

Many of the issues which are arising in health and social care are a direct result of the failure of the primary legislation which underpins the Care Quality Commission rather than a failure of the organisation itself and the solution is probably a step-change in the way that health and social care is regulated.

We are all too familiar with some of the problems in the independent sector:

  1. Medical treatments are classed as “not medical” and so not being CQC registerable
  2. Treatments being carried out by untrained and unqualified people
  3. Use of substandard or unregulated products for treatments
  4. Providers offering medical treatments without registration or supervision but with apparent impunity.
  5. Sale of products as medical devices which contain prescription medicines
  6. Lack of training, qualification or supervision of staff
  7. Failure to follow-up or support patients
  8. Neglect and mistreatment of patients
  9. Inadequate record-keeping and consent procedures
  10. And the list goes on...

The fundamental problem here is that we need to take a leaf out of the book (or maybe even the whole book) of the financial industry in its attempts to “clean up” its act. It is incongruous (if understandable) that our money is now more tightly controlled and better regulated than the providers of our health and care services. Is it not now time for us to seize the opportunity and make the necessary changes to ensure that patients receive the best possible and safest standard of care in our health and social care establishments whether in the NHS or the private sector?

CQC : Care Quality Commission or Can't Quite Cope?

So, how can we solve such diverse and seemingly fundamental problems?

A significant number of the problems above could be addressed by adopting one of the fundamental tenants of the financial services industry – and many of you will be shocked to know that this is not already the case – the so-called “general prohibition” on the provision of health and social care services without being authorised by the regulator, so that it becomes a criminal offence for any organisation or individual to provide any health or social care function without authorisation. This would mean that no one could simply set themselves up as a provider, advertise on their websites and treat patients without the real fear of prosecution – and of course, the regulator should be required to enforce it!

Once authorised an organisation must be required to adhere to Principle for business as well as good clinical practice (cf Essential Standards of Quality and Safety):

  1. Conduct itself with integrity
  2. Exercise skill, care and diligence
  3. Take reasonable care in management & control of the organisation
  4. Exercise financial prudence in the running of the organisation
  5. Observe proper standards of clinical conduct
  6. Give due regard to the interests of patients
  7. Ensure proper communication with and provide information for patients
  8. Avoid conflicts of interest with patient care and financial matters
  9. Promote the relationship of trust with patients
  10. Ensure adequate protection for patient’s physical and mental health
  11. Cooperate in an open manner with the regulator

The Principles should be supported by detailed guidance in a regulator’s handbook.

The same analogy could be drawn with the individuals working within an organisation. The Financial Conduct Authority (FCA) regulates individuals who carry out certain functions in the financial world. In the same way practitioners in the authorised health and social care organisations could be approved to provide certain categories of services based on qualification, training, experience and competence.

The whole system is underpinned by statutory personal responsibility at all levels both within the organisation – from the cleaners, right up to the Chief Executive. The regulator’s powers should be as extensive as in the financial sector ranging from information gathering to ordering the provider to commission expert reports, inspections, search, prohibition and financial enforcement. The lead of course by a top management team in the regulator who actually understands the sector rather than simply appointing former hospital managers who have little or no idea what happens in the real world!

We have cleaned up the financial world – should we now not do the same for health and social care, rather than simply tinkering about around the edges?

How about the Health & Social Care Regulatory Authority?

Hey, wait!

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