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The need for comprehensive and co-ordinated health and social care regulation came about following concerns in recent decades of poor practices, and inequality in access and provision across the country. Initiated by the Government, regulation of health and adult social care in England was carried out by the Healthcare Commission, the Commission for Social Care Inspection and the Mental Health Act Commission until 31 March 2009. 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 bodies. Independent providers such as primary dental care, ambulance services and GP practices are also included. The Commission was created in shadow form on 1 October 2008 and began operating on 1 April 2009.

The new system will create a joined-up ‘single system’ regulation for health and social care with the aim of ensuring better outcomes for the people who use services.  Although the CQC covers all of health and social care and not just services and structures relating to long term care, the system has the potential to regulate and monitor links and interfaces within long term care provision and safeguard and protect the rights of older people in need of care.

A new set of regulation requirements, priorities and guidelines were put in place in April 2010 following a large scale public consultation which was driven forward by the Government. These focus on outcomes, experiences and human rights of people who use health and adult social care services.  CQC’s functions are concerned with assuring safety and quality, assessing the performance of commissioners and providers, monitoring the operation of the Mental Health Act 1983 and ensuring that regulation and inspection activity across health and adult social care is coordinated and managed. All health and social care providers are required by law to register with the CQC in order to provide services. The registration requirements that all providers must meet are consistent across both health and adult social care. The approach is risk-based which means that regulation activity will be targeted where action is required.

A summary of CQC powers and duties:

The CQC uses a number of tools for regulating service provision and commissioning:

If the above tools identify risks to users, then the CQC will take steps to enforce improvement.

There are a number of incentives for agencies to improve the delivery of their care, however, the regulation system remains somewhat punitive with severe repercussions and penalties for those whose quality of care and patient safety is lacking.

CQC budget for 2010/11 is £161.2m/€190.2m) (total recurring revenue cost), a proportion of these resources are derived from registration fee income (£5,000/€5,900 per service), and the remainder is made up of grant-in-aid from the Department of Health (£63.8m/€74.3m). There will be an annual fee charged to NHS providers for regulation, ‘banded’ according to number of beds or income. For example, an acute provider with 0-250 beds will pay £15,000/€17,700; another provider with gross operating costs of over £1 million will pay £60,000/€70,800. CQC has a total staffing of 2,081 full-time equivalents. A model for the operations directorate involves regions delivering all main regulatory activities: registration; monitoring compliance and assessing performance, but with specialist nationally-based advice for registration, enforcement and provider relationships. There are also national operations delivering specialist statutory functions and joint inspection with other regulators (i.e. Ofsted, Youth Offending Teams). There is strong partnership and sharing of responsibilities between organisations to provide interfaces between operations staff and managing data/handling intelligence. The operations model has so far registered 378 provider trusts and it plans to register over 12,000 adult social care and independent healthcare providers, covering some 24,000 services.

The effect of the regulations and outcome measures were only put into place in April 2010 and have not yet been fully implemented, therefore their success and effectiveness is unknown, particularly in long term care. However, there are feedback mechanisms in place from providers and users that will feed into reviews and provide information on how the regulations are working. The changes have so far been systemic and are mainstream as all health and social care providers and commissioners must be registered with the CQC, but it is so far untested. In terms of resources used compared to the previous three organisations which it replaced, thus far the CQC have reduced the number of offices from 23 to 8, workforce from 2,900 to 2,100 and budget from £240m to £164m (€283m to €194m).

Inspection reports are available for public viewing via the CQC’s website. Thus service users are viewed as consumers of health and social care services who can select which services they choose to access based on performance. A negative consequence of the publication of quality reports for services is that any severe failings may be picked up by the media and the service’s public image may suffer for it.

In addition CQC are collecting a wealth of information about providers and are using this with their partner organisations to give illustrations of best practice and to develop training programmes. There is also a Regional intelligence and evidence officer who will interface with CQC to develop ways of data dissemination and evidence building.

Strengths

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Opportunities

Threats

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