We start exploring the organisational layout of the NHS as reported to Parliament and reproduced in our first post.
Body name: Care Quality Commission (CQC)
Place in the wiring: National Body (England)
CQC is the independent regulator of health and adult social care in England. It ensures that health and social care services provide people with safe, effective, compassionate, high-quality care and encourages service improvement. It monitors, inspects, and regulates services and publishes what it finds. Where they see poor care, they use certain powers to take action.
The Cost to March 2023 was:
Total operating expenditure: £248,699,000 (249 million)
Net operating expenditure: £29,838,000 (30 million)
The latest financial statement to 31 March 2023 does not match the figures in our Part 1 post.
The CQC's financial statement includes a footnote [1] showing further revenues. During the year, CQC received grant-in-aid funding of £97 million from DHSC. This funding, which is not included in comprehensive net expenditure but credited to the general reserve in the Statement of Financial Position, is a significant part of the CQC's financial operations.
Grant aid was used to finance non-chargeable operating expenditures (costs incurred that are not passed on to the end client) and fixed asset additions purchased (expenses added to the purchase price of an asset made after its initial purchase).
CQC says it is mainly funded through fees charged to registered providers, with the DHSC providing grant-in-aid (GIA) for costs that, under HM Treasury rules, are not chargeable through its fee structure.
So money flows to the hospitals, GP practices, and dentists, which pay money to the CQC to inspect them. The DHSC picks up the tab for anything that isn't covered in the inspectorate fees.
Number of Employees:
At the end of March 31, 2022, the CQC had 3,066 employees, including 87 apprentices.
According to Glassdoor, the average base salary for a CQC Inspector is £43,000 per year.
What does the CQC do?
The CQC produces inspection reports on services under its jurisdiction, from care homes to hospitals, dental care, and primary care. The areas are listed here and you can easily access them.
However it does not have a facility to scan all reports, even, say, those for care homes. So if you want to know about a particular aspect of care across the board you have to scan all 14,715 reports, one by one.
The CQC uses a traffic light grading system, so a green dot means good, either overall or under each of the five dimensions of the assessment: safe, effective, caring, responsive, and well-led. The way the ratings are calculated is explained here. This is how “safe” is defined:
Where people raise concerns about safety and ideas to improve, the primary response is to learn and improve continuously. There is strong awareness of the areas with the greatest safety risks. Solutions to risks are developed collaboratively. Services are planned and organised with people and communities in a way that improves their safety across their care journeys. People are supported to make choices that balance risks of harm with positive choices about their lives. Leaders ensure there are enough skilled people to deliver safe care that promotes choice, control and individual wellbeing.
We decided to use a “probe”, i.e. to look at one of the biggest problems facing nursing homes (as the recent pandemic has shown): infection.
We could not find any mention of this in the Nursing homes' reports, but there were several mentions in the hospital reports, although mainly centred on MRSA control.
Grey areas:
The CQC made a statement on the recent riots. We are unsure how that fits with the stated mission. We cannot assess the impact on citizen care and the regulator’s activity.
TTE Recommendations.
In October 2022, we recommended appointing an advocate for each patient, especially the frail, disadvantaged, or disabled. Christine’s law; lest we forget. Taking consumer apps as an example, could the CQC be substituted for a far cheaper, bottom-up reporting system from citizens or their advocates?
TTE considers there is a potential saving of £150 million at the CQC. For comparison, the Food Standards Agency's accounts, which ensure food safety, show a net cost of £130.5 million in 21/22. The CQC should do more for less, using a bottom-up approach that relies on patient-facing/advocate responses to direct care, clinician input, and a system responsive to whistleblowers when care goes wrong.
Next-up: Health Watch England
Two old geezer taxpayers wrote this post.
The CQC should be scrapped. The organisations it monitors are supposed to be professional and therefore should be regulating their own performance. If they have to exist they should have a single metric that drives their ethos - user satisfaction with the organisations they monitor.
Interesting that MRSA recording appears confined to hospitals. Before I retired our bacteriologist did a study in our hospital that showed that the majority of MRSA was imported from the community - so not hospital-acquired but hospital-identified.