The Care Quality Commission has seen a record rise in whistleblowing calls, but there are mounting fears that it lacks the “teeth” and resources to properly investigate nurses’ concerns.
Over the past two months, the CQC has received more than 200 phone calls highlighting problems with services, compared with fewer than 100 during the whole of last year, suggesting it is heading for a threefold year-on-year increase.
Speaking to the House of Commons health committee last week, CQC chair Dame Jo Williams attributed the rise to the publicity created by the abuse scandal at Winterbourne View nursing home in Bristol.
She added: “It’s very important that we respond well…because we know that for individuals putting their head above the parapet is very difficult and there have been situations where whistleblowers have lost their jobs.”
But she admitted the embattled regulator has had to ask the Department of Health for an extra £15m to ensure concerns were followed up with inspections. The CQC carries out around 600 inspections a month but Dame Jo said there was a need to “double that, at the very least”.
In May, the regulator stated in board papers that a shortage of resources had left it in a position where it would “almost certainly” risk “fail[ing] effectively to identify or deal with non-compliance, leading to persistent poor quality care for users and reputational damage”.
Royal College of Nursing director of policy Howard Catton said: “We would like an effective regulator with teeth. Given the scope of the CQC’s responsibilities, there are questions about whether it’s sufficiently resourced to do the job.”
More unannounced inspections and a greater focus on staffing levels were needed, he said.
The committee also raised the latter issue, questioning how whistleblowers were supposed to tell the CQC when staffing levels were too low given there was no “clear standard”, or staffing ratio, to judge this against.
University of Southampton professor of health sciences Peter Griffiths said it would be useful to have “some clear point of reference that can clearly distinguish general disgruntlement from something that says objectively there’s an issue of concern here”.
Ratios would not necessarily be right for every ward, and care needed to be taken to ensure minimum levels were not treated as targets, he added.
Concerns have also been raised about the CQC’s 350 vacancies, of which around 121 are for inspectors. About 70 job offers had been made in the past few weeks.
And the regulator has come under repeated fire during the ongoing public inquiry into Mid Staffordshire Foundation Trust.
National Patient Safety Agency director of patient safety Suzette Woodward said: “Mid Staffs shows us there are people who tried to speak out and weren’t heard, just as Winterbourne View has demonstrated.
“The CQC is trying to make lots of changes while the system is constantly changing around it. It needs to get it right during the transition, for patients and staff.”
In written evidence to the inquiry, Nursing and Midwifery Council chief executive and registrar Dickon Weir-Hughes criticised the CQC for lacking a director of nursing and carrying out inspections with only the “loose involvement” of a nurse or midwife.
At the moment nurses and midwives are invited to accompany non-clinically trained CQC inspectors on visits but are not involved in the process from the start.
Giving the example of the CQC’s current programme of dignity and nutrition inspections in acute trusts, Professor Weir-Hughes said this led to criticisms of the process from nurse directors.
A CQC spokeswoman said: “We have reviewed our whistleblowing policy and are actively promoting it online – we want and are getting more calls and the last two months have seen a record number. Our national advisors support CQC to make sure we understand issues in their profession that might inhibit whistleblowing.”