Magazine article Public Finance

CQC Gets to Grips with Registration Challenge

Magazine article Public Finance

CQC Gets to Grips with Registration Challenge

Article excerpt

'The idea that an NHS trust can just bump along the bottom without any improvement is gone,' says Cynthia Bower, chief executive of the Care Quality Commission.

To Bower, the final weeks before Easter represent a watershed, both in terms of her own work and for the running of the NHS. After just a year in existence, the CQC is on course to complete the registration of the 381 NHS trusts in England that provide health care services.

Registration will depend on trusts' ability to show they meet minimum standards - those that cannot will have conditions placed on their registration, and will retain their licence to provide services only if the CQC is convinced of their capacity to improve.

Some 66 trusts were confirmed as registered on March 18, with two more batches expected over the following two weeks. After that, the CQC will begin monitoring registered trusts. Then there's the small matter of registering 44,000 private health and social care providers.

Anna Dixon, acting chief executive of the King's Fund, says just getting to this stage is no mean feat given the project's 'ambitious timetable'. The CQC has had to draw up and consult on the set of 16 standards that providers are measured against, and then process a wealth of data from each of the trusts.

It hasn't been an entirely bump-free ride. Bower tells Public Finance that the CQC and all the NHS trusts have had to work 'phenomenally hard' to get the system up and running inside 12 months.

She says the process has shown that the CQC needs to strengthen the support it gives to NHS bodies.

We've been inventing a new system and trying to implement it at the same time,' she says.

'The best lesson we've learned is how we sharpen up our advice to make sure we're giving consistent advice and that our staff understand the system as well as they need to.'

At the time of going to press, only two trusts had been registered with conditions imposed: Milton Keynes Hospital NHS Foundation Trust and Mid Staffordshire NHS Foundation Trust.

Neither case should come as a surprise. In Milton Keynes, foundation trust regulator Monitor forced the hospital to bring in a team of clinical experts earlier this month amid concerns over the hospital's maternity ward. Mid Staffordshire, meanwhile, was at the centre of a patient safety scare last year after an investigation by the CQCs predecessor, the Healthcare Commission, found systematic failings in care.

Both trusts said the CQCs conditions highlighted problems that directors were already aware of- and plans to remedy the situation were being implemented.

But conditions are not being imposed on every trust that has given cause for concern. The Royal Cornwall Hospitals NHS Trust has been registered without conditions, despite being placed among the bottom 5% of trusts by the CQC, which rated it 'weak' for the quality of its services in last October's annual health check.

Bower says registration, which replaces the old performance rating system, has different criteria and, as such, direct comparisons will not tell the whole story.

She argues that linking the licence to practise to minimum standards has 'absolutely made trusts focus on how they can assure themselves that care is safe'.

For those that aren't making the grade, attaching conditions to the registration - with the implicit threat of revoking their licence if there is no improvement - has awoken under-performing trusts to the need to get their act together, she says.

'We want a system that doesn't catch organisations out but that works with them to generate improvement,' Bower adds.

None of this sounds contentious but it nevertheless represents a subde change in the role ofthe regulator. …

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