Q and A: who regulates care homes?

Who regulates care homes and residential hospitals?

The Care Quality Commission (CQC) regulates all health and adult social care services in England, whether they are provided by the NHS, local authorities, private companies or voluntary organisations.

Its website states: “The CQC makes sure that essential common quality standards are being met where care is provided, from hospitals to private care homes… The CQC’s aim is to make sure better care is provided for everyone, whether that’s in hospital, in care homes, in people’s own homes or elsewhere.”

How does it regulate facilities and what powers does it have?

As of April last year, all regulated health and adult social care providers had to register with the CQC to show they met essential standards. Without registration, providers are not allowed to operate.

The CQC keeps check on facilities with regular inspections – at least one “review” every two years. It also takes in feedback from those who use the service, and can be contacted by whistleblowers.

It can then take action if it believes there are problems or standards not being met – including fines and public warnings. In an emergency situation, it can also demand a service is closed until the provider meets its requirements, and it can take a service off the register completely if necessary.

Serious questions to answer
David Congdon, head of campaigns and policy at Mencap, told Channel 4 News there were lots of questions that needed to be asked over the regulation of adult social care. 

"The historical criticism of inspections would be that there was no detail - they checked if there were lightbulbs, or toilet roll, and if not you fail - what we would call, pejoratively, the 'tickbox' mentality. The issue is to what extent you talk to the users, the staff, get honest and independent views, and look out for warning signs. Too often, when things go wrong, you find there is history. 

"So to be frank CQC has to ask serious questions about how it does the inspections." 

He said CQC also needed to consider why, in Bristol, the whistleblower's complaints were not followed up - but he said it wasn't the only organisation to blame. 

"Social services still have responsibility. I think they have some questions to answer as well. And the health service was paying the bill - what were they doing? There are some systemic problems." 

What happened in Bristol?

At Winterbourne View residential hospital in Bristol, where undercover footage filmed earlier this year by the BBC’s Panorama apparently shows serious abuses, a whistleblower did complain to the CQC. There were also inspections by the regulatory body in December 2008, March 2009, and December 2009, Channel 4 News has learned. There were two further visits by Mental Health Act Commissioners, who visit those detained in hospitals under the Mental Health Act, in June 2009 and September 2010.

Finally the hospital had to complete an assessment in October 2010 to be registered by the CQC – but this did not include a site visit. But the alleged abuse appears to have been missed.

In a statement, the CQC said: “CQC was contacted by a former member of staff on 6 December, having already been advised of whistleblowing concerns by the local authority at the end of November. These concerns had been passed to the local authority by the hospital’s manager.

Read more on what happened in Bristol - and what will happen next 

“As the safeguarding lead, the local authority had already set up a safeguarding meeting to look at these issues which, though concerning, were not as detailed or specific as the information revealed by Panorama. So CQC took the view that the concerns were being examined. For a variety of reasons, that safeguarding meeting did not take place until February.

“However, we recognise that, had we contacted the whistleblower ourselves directly after we received the email, we would have been alerted to the seriousness of the situation and moved swiftly to inspect the hospital.”

The CQC is now planning a review of what happened, a review of the hospital operator, Castlebeck, and more inspections across all hospitals which provide care for people with learning disabilities.