The effect of costs on quality of care

Abstract

by the Healthcare Commission’s predecessor—the Commission for Health Improvement. Amid austerity elsewhere in the public sector, the CQC has been one of the few public bodies actively recruiting for expansion. Now, amid an overall promise to protect NHS spending and inject at least an extra £8 billion over the next few years, the CQC has been asked, like most of the rest of the public sector, to model cuts of 25 % and 40 % in its funding, even as its remit for hospital inspections is being broadened to take into account not just the quality of care being provided, but how well the hospital uses its resources—territory that overlaps with what we must not learn to call NHS Improvement (the old Monitor and Trust Development Authority). In other words, the pendulum of inspection is swinging once again. A 25 % cut, let alone a 40 % one, will mean, inevitably, fewer inspectors and more reliance on data for riskassessment, although the distinction should not be taken too far. The CQC quizzes plenty of data. The cuts, of course, may not be as bad as that, but if they are on anything like that scale, one has to have sympathy for anyone trying to run an organisation whose size goes in and out like a concertina, and whose role in life is so subject to political fashion— jumping from a demand for more inspection to less inspection to more and back again. At the heart of this is a lack of clarity first from Labour, then from the coalition, and now from the Conservatives about exactly what they expect inspection to achieve, and over how it should be done. Clearly, inspection is meant to stop bad things happening, but beyond some very basic levels of health and safety, it is not clear that inspectors do that. Values and culture within organisations are far more important and they are notoriously hard to inspect on a consistent external basis. An ability to intervene when bad things come to light is clearly needed, but is routine inspection the way to prevent them in the first place? There is a real conundrum here, which governments appear still to be a long way from solving. So the pendulum swings without it being entirely clearly quite what is being achieved—and whether spending more money on this, or less money, alters the quality of care for those receiving the service. It looks as though the CQC is about to go around that course again. BJHCM Nick Timmins, senior fellow at the Institute for Government and the King’s Fund, asks what effect the cuts to the Care Quality Commission may have. The effect of costs on quality of care