Following its annual review of the work of the Care Quality Commission (CQC), the Health Committee reports that the bias of the work in the CQC away from its core function of inspection and towards the essentially administrative task of registration, represents a significant distortion of priorities. The Committee reports that: the CQC was established without sufficiently clear and realistic definition of its priorities and objectives; the timescales and resource implications of the functions of the CQC were not properly analysed; the registration process itself was not properly tested and proven before it was rolled out; the CQC failed to draw the implications of these failures adequately to the attention of ministers, Parliament and the public. Consequently, the Committee welcomes the government's decision to postpone registration of GP practices, and recommends that proper planning, including piloting of the model for registration, should be undertaken before the revised date of April 2013 is confirmed. The Committee also welcomes recent announcements that the CQC intends to undertake annual visits of all NHS and social care providers. It goes on to stress the importance of the role of inspectors in assessing the culture in care providers, especially concerning the obligation which rests on all healthcare professionals to raise concerns if they recognise, or ought to have recognised, evidence of failure of professional standards. Each provider organisation should recognise and respect this professional obligation and provide proper security to those professional staff who discharge it effectively.

The failures of Care Quality Commission (CQC) prompted the Department of Health to undertake a performance and capability review which produced a wide range of recommendations. The decision by CQC board member Kay Sheldon to give evidence as a whistleblower added to the controversy. She identified serious failings within the management, organisation, functions and culture of the CQC and it is unacceptable that the CQC failed to address and act on them before she felt compelled to approach the public inquiry. It is clear from the evidence presented by the CQC's outgoing Chair, Jo Williams, and recently appointed Chief Executive, David Behan, that the regulator is aware of the reforms that must be implemented. The CQC's primary focus should be on ensuring that the essential standards it enforces can be interpreted by the public as a guarantee of acceptable standards in care. The CQC's essential standards in their current form do not succeed in this objective. Equally, the CQC must be far more diligent in communicating the outcomes of inspections, especially to residents in social care and their immediate family. In the long-term, the CQC has a role to play in facilitating a culture of challenge and response across health and social care so that identifying and addressing failings becomes a standard process for staff and management. Providers must support staff in raising concerns in order for those staff to meet their own professional duties. Those organisations who fail in this obligation should be refused registration by the CQC.

Responses to HC 1428, on the Annual accountability hearings with the Nursing and Midwifery Council (ISBN 9780215560933); 1429 on the Annual accountability hearings with the General Medical Council (ISBN 9780215560926) & 1430 on the Annual accountability hearings with the Care Quality Commission (ISBN 9780215561305)

This is the second annual accountability hearing with Monitor from the Health Committee. The parallel roles of Monitor and CQC were criticised in the Francis report on the Mid Staffordshire Foundation Trust (HC 898, session 2012-13, ISBN 9780102981469) because they created significant opportunities for confusion. The Health Committee concurs and stresses that it needs to be addressed urgently to avoid the twin dangers of gaps in regulation and duplication of regulation. This report concludes that the proposal to use a combination of transitional powers and licensing provisions (designed to apply to all providers of NHS care) to provide the framework for the long-term regulation of Foundation Trusts is profoundly unsatisfactory. The role of Monitor in relation to competition in the NHS remains unclear, and the respective roles of Monitor and the Competition Commission in the market for health and care services need urgent clarification. Monitor's positive approach towards the commissioning of integrated care pathways is welcome. Monitor should use its role in setting the tariff paid for certain NHS services (alongside the NHS Commissioning Board) to encourage system redesign and the integration of service provision, as well as to discourage "cherry-picking" of the most economically attractive patients. The establishment of a provider failure regime is welcome, but a number of important elements in that regime are not yet fully developed and further progress is needed over the coming months.

The Nursing and Midwifery Council (NMC) is a vital safeguard for care quality and patient safety, but "over a number of years the NMC has failed to understand its function and properly prioritise patient safety". The new management team in the NMC is committed to address its failings. However there continues to be a serious gap between current performance and acceptable standards. The NMC has proposed that fitness to practise cases should be decided on average within 18 months of a complaint being received; the Committee proposes that this should be reduced to 9 months, with a maximum of 12 months. The NMC also has had a poor track record of fitness to practise decisions being challenged and overturned. The CHRE has needed to almost routinely refer NMC decisions to the High Court. It is also unacceptable that the NMC underestimated the budget for its fitness to practise directorate by 30%. The Government's intervention to limit the effect of the fee increase on registrants is welcomed. However, nurses and midwives still face a 32% fee increase at a time of public sector pay restraint. A further fee increase can not be justified and the NMC should consider introducing a phased payment system for registrants. The language and communication skills of nurses and midwives remain a concern. MPs also question why the NMC has made such slow progress on a system of revalidation. Lastly, many of the NMC's problems stem from inadequate IT infrastructure where two key systems cannot communicate directly and deliver incomplete or inaccurate information

In this first annual accountability hearing with Monitor, the Health Committee welcomes the strengthened role given to the hospital regulator in the approval and regulation of Foundation Trusts. The Committee strongly supports the view that the standards for authorizing Foundation Trusts must not fall as a result of the Government's desire to see all remaining NHS Trusts become Foundation Trusts. It welcomes the extension of Monitor's oversight powers for Foundation Trusts to 2016; that the powers will then be reviewed; and the fact that Monitor's new role, as set out in the Health and Social Care Bill, has been more clearly defined. The Committee believes Monitor has established a reputation as an effective regulator of Foundation Trusts and that it is important to safeguard that hard-won reputation. That means insisting on the maintenance of a rigorous approvals system. It also means maintaining an effective oversight regime in what are likely to be increasingly challenging times. Finally, following government amendments to the Health and Social Care Bill which were tabled at Commons Report Stage, it means the operation of an effective distress and failure regime for Foundation Trusts.

A draft Law Commission Bill on the regulation of health and social care professions sets out the framework for a negative register, but it was not included in the Queens' Speech either as a draft or a substantive Bill. The Government needs to set out what changes to the powers of regulators it is planning to make through secondary legislation instead. Following up themes in the Francis report, regulators need to be visible and accessible to registrants, and also to patients and members of the public who wish to raise concerns about patient safety. Since 2003, the HCPC has recommended that statutory regulation be extended to a further eleven professions from the current sixteen. Of these, the only groups to receive statutory regulation to date are operating department practitioners and practitioner psychologists [the other groups are Clinical Perfusion Scientists, Clinical Physiologists, Dance Movement Therapists, Clinical Technologists, Medical Illustrators, Maxillofacial Prosthetists & Technologists, Sports Therapists, Sonographers and Genetic Counsellors]. The HCPC should list any professional groups for which they feel there is a compelling patient safety case for statutory regulation so that this can be pursued with the Department of Health as a matter of urgency. There is also concern at the length of time it can take for professional groups to gain statutory regulation. Given that new groups can be added to the HCPC's register by means of secondary legislation, there should be no undue delay in extending statutory regulation to professional groups where there is a compelling patient safety case for doing so