The Care Quality Commission has admitted that scores of its inspectors were appointed despite falling short of its own recruitment standards, creating the risk that its regulatory judgments could be “impaired”.
Details of the CQC’s “significantly flawed” recruitment process, which ran from January to December 2012, were laid out in an internal report, presented to its audit committee in March and obtained by HSJ under the Freedom of Information Act.
It revealed that the watchdog, which inspects thousands of health and social care organisations each year, employed 134 applicants in 2012 who “failed some or all of its recruitment activities”. Of that group 121 are still in post, the CQC told HSJ.
The CQC currently employs 1,031 inspectors, meaning more than one in 10 was appointed under the defective regime.
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The procedure breaches - reported to senior managers in June 2013 - meant some staff “may have lacked the competencies required to undertake the work for which they were employed”, the report said.
There remains a “residual risk” to the CQC’s regulatory judgments, it added (see extract, below). “This in essence implies that our regulatory judgments may be impaired as we have not always appointed staff with the core competencies required to do the job properly, and they may not have received appropriate training to bring them up to the standard required.”
The report stated that the regulator is unable to dismiss inspectors recruited under the flawed process. “It is not possible to force termination of their employment because the individuals themselves were unaware of the flawed process,” it said.
“The CQC could face the risk of constructive dismissal.”
Instead, the watchdog will “continue to support this group to deliver their role”.
The recruitment flaws occurred in 2012 amid concerns that the CQC was “struggling to meet inspection performance targets” and fill vacancies, according to the report. The heavily redacted paper does not clearly explain how the recruitment process was altered.
The regulator said it had taken steps to mitigate risks when the breaches came to light “by conducting a full review of practices and process”. “The pass criteria is set and has been tested to confirm the benchmarks are appropriate and will not be altered or influenced by others,” the report added.
According to minutes of its March meeting, the CQC audit committee voiced “serious concern” at what happened, describing it as “indicative of a lack of clarity in management delegations, combined with unacceptably poor recording practices”.
‘Flawed’ process: Precursors to the 2012 problems
The Care Quality Commission began a major recruitment drive in July 2011 after unveiling plans to inspect every health and social care provider at least once a year.
This ramp up of the inspection regime followed revelations of abuse suffered by people with learning disabilities at Winterbourne View Hospital, and criticism of the CQC in relation to the scandal of care failings at Mid Staffordshire Foundation Trust. It marked a significant departure from the regulator’s previous “light touch” approach.
But while its workload increased, the CQC struggled with a shortage of inspectors, following a restructuring in 2010, high staff turnover and a government imposed public sector recruitment freeze.
Months after the Department of Health approved a major recruitment drive in June 2011, the CQC judged that vacancies were not being filled quickly enough. The breach of procedures followed soon after.
The CQC told HSJ its HR leadership and recruitment process had changed since 2012. HR services group Penna has been contracted to design and run the majority of the process.
All 134 inspectors employed under the flawed regime were subject to a six month probation period during which their performance was monitored, as is the case with all its new recruits, a CQC statement said.
Any inspectors who had failed to demonstrate adequate performance during this period would not have continued with their employment, it added.
The regulator also said it had evidence suggesting the 121 individuals had performed broadly in line with the overall inspection workforce.
CQC chief executive David Behan said: “As soon as this issue was brought to our attention, we investigated the operation of our recruitment processes in 2012.
“From this, it became clear that our process at the time had not been followed consistently.
“Having identified this, it has been reported to our audit and corporate governance committee and during a public board meeting.
“To reflect the fundamental changes that we have made to the way we regulate health and adult social care in England, we now recruit people with specialist experience in healthcare, primary medical services, and adult social care and our recruitment approach has been updated to reflect this
“This issue is not about individual inspectors but about the systems and processes used at the time, which we have changed.
“All of our inspection staff, regardless of when they were or are appointed, receive training, are subject to a probationary period, regular performance management reviews, one-to-ones, and their work is quality assured.”