Criticism as under pressure CQC reveals 14 per cent underspend

The news comes despite the CQC being under fire for failing to spot evidence of poor care, such as that allegedly suffered by people with learning disabilities at the Winterbourne View care home near Bristol. There have also been growing calls for the quality of inspection to improve.

At the end of quarter 2, the organisation’s budget was 28 per cent underspent.

In a statement, the CQC said the underspend was predicted to be £14m at year-end, or 14 per cent of the total budget. The commission attributed the underspend to the time taken to recruit new inspectors, savings on ICT and premises, and the delay to GP registration which was originally due to be completed by this spring but has been put back a year.

The underspend was highlighted in an HSJ interview by Kay Sheldon, one of the regulator’s non-executive directors. She said she had found it extremely difficult to get detailed information from the CQC on expenditure, making it impossible to judge whether it was using its resources effectively.

Ms Sheldon’s future on the board appears uncertain after she gave a highly critical testimony to the Mid Staffordshire Foundation Trust public inquiry, describing the organisation as reactive and lacking a coherent strategy.

Speaking to HSJ, she expressed concern that planned “major” changes to the CQC’s enforcement regime had not been adequately publicised and claimed proposed changes to how the regulator judges compliance will mean a further move away from its original strategy of encouraging improvement to becoming increasingly “punitive”.

Calling for a wide debate on the role of regulation, Ms Sheldon said: “What we are doing at the moment is too influenced by the government which is to focus on failure and not contributing to wider improvement. From [the government’s] perspective, that’s fine because they don’t want scandals and CQC would take the blame if something major was missed.”

Under the proposed changes the CQC will judge organisations as compliant or non-compliant, but will no longer rate organisations “compliant with improvements needed”.

The CQC’s impact assessment of the changes estimates up to 9 per cent of providers will move from being compliant to non-compliant in the first year of the new regime, which is due to begin in April.

Ms Sheldon argued this was against the Hampton Principles of regulation, which say enforcement action should be a last resort and claimed supporting evidence and costing data in the impact assessments for the changes lacked detail.

Her views are supported by the NHS Confederation’s response to the consultation, which describes the impact assessments as “superficial” and shares concerns about ending the use of improvement actions.

A spokesman for the CQC said the regulator had consulted widely on the proposed changes to the enforcement regime and that enforcement would remain a last resort, to be used only if organisations do not respond to compliance actions.

Ms Sheldon began formally raising concerns about the CQC’s lack of strategy a year ago and contacted the public inquiry in November, after becoming frustrated her concerns were not being listened to.

She said: “It’s difficult to discharge your duties as a board member without a clear strategy; the goal posts keep moving and you need to ask for more information but you don’t always get it or you might get people into trouble.

“There have been suggestions that I shouldn’t have got involved in the details, but if you think about Mid Staffs one question there was ‘why didn’t the board know what was going on?’.”

She added: “I thought about resigning but as a public board we have certain duties, and if I walked away I would not be discharging my responsibilities.”