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Health reforms place even greater burden on an inspection regime that can’t cope

Winterbourne View care home scandal in the pressThe Care Quality Commission has come under a lot of flak for the failures of private social care providers like Winterbourne View. Part of the problem is that CQC have simply too much to do and not enough staff to do the work. Currently CQC has 350 job vacancies, including 121 inspectors, so there is clearly a reluctance of qualified people to work for the commission. A combination of too much work and not enough staff results in delays and mistakes, and as the government expands the number of healthcare providers this will mean even more work for the commission, already creaking under the strain of its current workload.

CQC was created in April 2010 to take over the responsibilities of the Healthcare Commission. Initially the CQC had a remit to inspect the 400 NHS Trusts and Foundation Trusts and ensure that they were compliant with quality standards. In October 2010 CQC started inspecting the 12,500 adult social care providers and 1,500 private healthcare providers, and from April this year CQC took on the role of inspecting the 8,000 dentists and 200 private ambulances. As you can see, the organisation is being given more and more work to do at a time when it is showing that it cannot do the work it already has.

So what does the government propose? The government intends to make CQC responsible for even more providers! From April 2012 it will inspect the 9,000 or so GP practices and out-of-hours services across England, and also the currently unknown number of Any Qualified Providers.

The government's plan is to open up the entire NHS to Any Qualified Provider. The Any in this phrase applies to the Provider, meaning that patients should be able to choose any provider who is qualified to do the work. The Qualified means that they have to register with both Monitor – who will check the provider's financial governance – and CQC, who will determine if the organisation can provide the care to the minimum standard. The government's intention is for there to be thousands of new AQP providers ranging from individuals, to groups of people working as a profit-share mutual or social enterprise, to profit-making private providers.

The NHS white paper from last year says that AQP will be a reality in "the vast majority of NHS-funded services by no later than 2013/14", and the the NHS Operating Framework 2011/12 says that AQP will be introduced for community services (eg district nurses, physiotherapists, podiatrists, speak therapists) from 2011/12. Clearly the roll out of AQP is moving very fast, and soon – if government hopes are realised – the CQC could have thousands of new providers to inspect.

However, CQC inspections are not free. The current fees state that healthcare providers will pay between £1,500 to £48,000 depending on how many locations they operate. A large healthcare organisation can absorb such costs, but a small organisation (say, an individual physio or group of district nurses) will find such fees a burden. The costs of CQC registration may mean that only large private providers will be able to afford to be an AQP, but even so, the work of CQC will still be increased.

The government's plan to privatise the NHS piecemeal is gathering pace – but quality and regulation of providers is clearly an issue that has not been thought through. The CQC clearly does not have the capacity to inspect all of the new providers and this may mean that cases like Winterbourne View could occur in healthcare.

Richard Blogger writes about the NHS and social policy at NHS Vault.


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