A High Court judge has ruled in favour of NHS healthcare provider SSP Health after an 18-month dispute around the processes followed by CQC to reach its ratings. The judge agreed that the CQC’s failure to fully engage with the provider had resulted in inaccurate conclusions and ratings with consequent reputational damage to SSP Health.
The ruling, announced in court last Friday, is expected to have widespread implications for how the Care Quality Commission (CQC) assesses the performance of providers of NHS healthcare services prior to publication of ratings reports. The Care Quality Commission was set up in 2008 as part of the development of the 2008 Heath and Social Care Act and is tasked with carrying out periodic reviews of the performance of regulated activities by all service providers.
The controversy dates back to November 2014 when CQC inspected Seaforth Village Practice but, according to SSP Health, failed to gather full evidence. CQC failed to speak to relevant senior staff present on the day and made no attempt to understand the context and circumstances in which the practice was working.
Following this initial review, Dr Shikha Pitalia, GP and Director of SSP Health wrote a letter to Professor Steve Field, the CQC’s Chief Inspector of General Practice, raising a number of concerns about the manner in which the inspection was carried out and, crucially, urging for publication of the report to be delayed. Dr Pitalia offered to explain the federated model in which the practice was working to allay concerns over the erroneous issues identified at the flawed inspection.
Unfortunately, Professor Field maintained that the findings were correct and refused to postpone publication of the report. This lead to major reputational damage to both the practice and SSP Health due to a succession of media headlines which inaccurately painted the practice as a failing organisation.
SSP Health followed the process as outlined in the CQC’s Provider Handbook by submitting factual accuracy logs and lodging a request for a review of ratings. Sadly CQC failed to accept the submissions made at the factual accuracy stage and further refused to accept SSP Health’s request for a review of ratings. Instead, a senior CQC official advised Dr Pitalia to seek legal advice as the only way forward.
As such, SSP Health instigated litigation procedures in partnership with Accrington law-firm QualitySolicitors Acklam Bond against the CQC in late 2015. Having heard the evidence, the Court, delivering critical judgment of the CQC, held that on at least four of the challenges made by SSP health, the CQC should have re-considered its position. That Dr Pitalia’ s reasonable request for it to review or reconsider its responses prior to publication of the report was rejected out of hand was also criticised.
A secondary inspection in September 2015 concluded an overall rating of ‘Good’ in the subsequent CQC report published in October 2015. SSP Health maintain that the systems and processes at both inspections were the same. The only substantial difference was that at the second inspection, SSP Health senior team insisted that the CQC inspectors engage fully with the wider team to provide the context and circumstances in which the practice was working. However, SSP Health claim that irreparable damage was done to both the practice and organisation’s reputation in this time and believe that the erroneous initial report should be quashed.
Dr Shikha Pitalia, GP and director of SSP Health, stresses that “SSP Health has always supported the role of regulation of services. However, as one of the largest GP providers in the country, and the recipient of over 40 CQC inspections in the last 2 years, we are acutely aware of the inconsistencies between individual CQC inspection teams. We felt it imperative to challenge the subjective methods CQC inspectors adopt.” Dr Pitalia further asserts, “This style of inspection is seriously flawed and causes undue damage to practices, staff and patients. In an era of unprecedented GP workforce crisis and limited NHS resources, CQC’s inaccurate conclusions risk serious compromises to the delivery of patient services.”
Last week’s ruling is a validation of SSP Health’s concerns and now raises serious questions as to how quality control of the CQC’s own processes can be monitored and ensured. In Friday’s hearing, Mrs Justice Andrews issued a declaration that the CQC should now in all cases carry out an independent review on the decisions made following an initial challenge to the CQC’s draft report. This clearly has far reaching consequences as it adds an extra layer of review prior to the publication of a report and which had previously been missing from the process.
Mrs Justice Andrews advised the CQC to reconsider the findings of the initial erroneous report at Seaforth.
Denise Bond, Litigation Partner at QualitySolicitors Acklam Bond, comments ‘We are delighted that Mrs Justice Andrews has arrived at, what in our view is, a common sense judgment. SSP Health’s organisational reputation has suffered damage on the basis of what we believe to be an assessment process that was flawed from the outset. We see Mrs Justice Andrews’ ruling as a validation of SSP Health’s approach to delivering healthcare services on a robust federated basis and it is our sincere hope that the organisation can move through this difficult period and continue to deliver vital healthcare services to people across Merseyside and the North West .’
Simon Butler, Counsel for SSP Health Limited said:
“The CQC must act fairly when inspecting medical practices. This means that the CQC must refer disputes of fact to an independent person for determination before publishing the final report. The CQC failed to uphold proper standards of fairness in this matter and caused the clients considerable inconvenience and distress. This unsatisfactory state of affairs could have been avoided”