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CQC should assess 'culture' during inspections


The Care Quality Commission should focus more on the culture of the organisations they inspect and the “essential quality of care” provided and not just “easily measurable inputs”, an influential group of MPs has said.

The Commons’ health select committee today published a report on the healthcare regulator. It is the second in a series of annual reviews.

It concluded there were still issues with the regulator’s consistency of inspection judgements, use of resources and clarity of purpose.

The committee called on the CQC to undertake an open consultation on its methods, which should include asking how inspectors could assess the prevailing culture among staff within individual care providers.

Committee chair Stephen Dorrell said: “An inspection should be much more than a review of facilities and records. It should include an assessment of the quality of the professional culture within the organisation.

He added: “Care providers need to show they have robust procedures which foster a culture of challenge and response in which the requirement to recognise and address service shortcomings is a standard process for all staff in pursuit of their professional duties.”

The committee welcomed the CQC’s recent introduction of a bank of clinical advisers who can be called in to help with inspections.

However, it noted that only 13% of inspections had drafted in one of these individuals since the facility was introduced.

The MPs also called for an “overhaul” of the CQC’s governance structures “as a matter of urgency” to provide proper “strategic direction”.

The report vindicated a CQC non-executive director, Kay Sheldon, for contacting the Mid Staffordshire Foundation Trust Public Inquiry with her concerns about how the regulator was being run in late 2011, describing her concerns as “legitimate”.

Mr Dorrell said: “It is regrettable that [Ms Sheldon] felt compelled to approach the Mid Staffs Public Inquiry to secure a hearing for her concerns.

“It is essential that the CQC reforms its culture and working practices to address these shortcomings.”

Last year was a turbulent time for the regulator’s leadership. Its chief executive, Cynthia Bower, resigned in February on the same day that the Commons health committee published its first annual review of the regulator.

Its chair Dame Jo Williams resigned in September. She had faced calls to go since she tried and failed to have Ms Sheldon sacked.

In response to the report, current CQC chief executive David Behan said the regulator had already held a strategic review, which had included consulting widely on a “clear statement of our purpose and role”.

“We also set out our intentions to tailor the way we regulate different types of organisations based on what has the most impact on driving improvement. We will put people’s views at the centre of what we do,” he said.

Peter Carter, chief executive and general secretary of the Royal College of Nursing, said: “We know that the culture of healthcare organisations cannot be regulated, however, we agree with the report that the CQC can play a vital role in ensuring that organisations support staff in raising concerns without fear of retribution.

“We look forward to continuing our work with the CQC in this area to make sure staff are fully supported.”

He added: “It is significant that the CQC is now giving attention to the importance of staffing levels and highlighting the effects of inadequate staffing on patient care.”


Readers' comments (20)

  • michael stone

    I've gone on about the difference between 'sensible measures' and 'easily measurable measures' before ! The NHS seems to regard only 'countable things' as being important - not true, even if assessing hard-to-measure things is much more difficult.

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  • michael stone

    I've commented about the difference between useful metrics and easily measurable metrics, before.

    The NHS seems to normally only bother to consider those things which are 'easily countable' and pays much less attention to other 'harder to measure' things, which are in some cases more important !

    This introduces a sort of 'analytical/conceptual bias' into the analysis of NHS issues - not very helpful !

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  • michael stone

    Grr - site crashed and appeared to have not posted my first comment, then after I'd typed and entered the second, both appeared !

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  • the intangible in nursing care is just as important as the tangible as is intuitive thought as much as deductive reasoning.

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  • tinkerbell

    Anonymous | 9-Jan-2013 10:51 am

    well said. We need to be able to 'sense' as well that something is not quite right and use that inner teacher to keep our eyes open to see so that we can observe what is going on around us that might give an indication that all is not as it might seem on the surface. It's about remaining alert and nipping things in the bud.

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  • Is it implied in the report that the CQC still has not got adequate resources. I see the private sector itching to get in like Ofsted.

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  • tinkerbell

    Perhaps a few more nurses like Terry working for them would help.

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  • looks like cqc need to engage deeper and more effective critical thinking skills.

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  • why wasn't this being done in the first place?

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  • I am Canadian and going through the same.......
    As said about easily measurable vs. less easily....
    Worked for 2 decades with staff that knew of my mental illnesses and managed to almost complete PhD...
    until moved hospital and voluntarily disclosed......I am in the process of being investigated....a nurse I had after cholecystitis from my old hospital said you were always the "go to nurse".......
    The Positive-I lived and worked in an amazing environment for over 20 years, then no-but has led me on a crusade to change mental health for health care professionals in all aspects..Patch (Dr. Adams) sent disciplines right out of our magazine...I will be polite and not tell you his reply.
    NURSE/KATE MIDDLETON-likely dysthymic or some level of depression, but as a previous researcher and educator and nurse.....I believe this statistically could be proven to be the cliff to suicide.I know .......
    I received my documentation from the College of Nurses 2 weeks after an intensive long program IMAP(integrative mood and anxiety)-I was feeling better than I had in 2 years-ready to take on all that life had to offer, then I opened that document. I can not tell you how that affected me. I can not describe.......

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