– gp surgeries, walk-in centres and out-of-hours care hospices – end-of-life care and care of people with life-limiting illness hospitals – nhs and independent hospitals mental health – services for people with mental health issues including detained patients services in the home – care home agencies, mobile doctors and services provided over the phone cross-sector inspections children's services – co-operative inspections of children's health services defence medical services – co-operative inspections of military medical treatment facilities secure settings – co-operative inspections of prisons urgent and emergency care systems – inspection of a&e and other urgent care services hospital inspections basildon and thurrock university hospitals nhs foundation trust in november 2009 barbara young, then the cqc chair, resigned from the commission when a report detailing poor standards at basildon and thurrock university hospitals nhs foundation trust was leaked to the media. the report found that "hundreds of people had died needlessly due to appalling standards of care." one month earlier the commission had rated the quality of care at the hospital as "good." grant thornton report main article: furness general hospital scandal in august 2012 chief executive david behan commissioned a report by management consultants grant thornton. the report examined the cqc's response to complaints about baby and maternal deaths and injuries at furness general hospital in barrow-in-furness, cumbria and was instigated by a complaint from a member of the public and "an allegation of a "cover-up" submitted by a whistleblower at cqc." it was published on 19 june 2013. among the findings, the cqc was "accused of quashing an internal review that uncovered weaknesses in its processes" and had allegedly "deleted the review of their failure to act on concerns about university hospitals of morecambe bay nhs trust." one cqc employee claimed that he was instructed by a senior manager "to destroy his review because it would expose the regulator to public criticism." the report concluded: "we think that the information contained in the report was sufficiently important that the deliberate failure to provide it could properly be characterised as a 'cover-up'." david prior, who joined the commission as chairman in january 2013, responded that the organisation's previous management had been "totally dysfunctional" and admitted that the organisation was "not fit for purpose." on 20 june 2013, behan and prior agreed to release the names of previously redacted senior managers within the grant thornton report, who it is alleged had suppressed the internal cqc report. the people named were former cqc chief executive cynthia bower, deputy ceo jill finney and media manager anna jefferson. all were reportedly present at a meeting where deletion of a critical report was allegedly discussed. bower and jefferson immediately denied being involved in a cover-up. the guardian newspaper reported on 19 june 2013 that tim farron mp had written to the metropolitan police asking them to investigate the alleged cover-up. following an investigation, cqc found that jefferson had not been party to any alleged 'delete' instruction. jefferson was cleared of any wrong-doing and cqc apologised for the distress caused by the allegation. finney subsequently started litigation seeking at least £1.3 million libel damages from the cqc on the basis that the cqc's current chair david prior and chief executive david behan abused their power and acted maliciously in publishing allegations that she ordered a "cover-up" of its failings. the grant thornton report said it was "more likely than not" that ms finney had ordered the deletion of an internal report by louise dineley, the cqc's head of regulatory risk. the cqc started litigation against grant thornton claiming a contribution towards any "damages, interests and/or costs" incurred in the case. social care residential establishments, unlike hospitals, can easily be closed, or sold, and reopened with a new identity. private eye reported in november 2015 that most of the 34 homes closed during cynthia bower's tenure after failing their inspection later reopened with a new name or under new ownership, but with similar problems. the campaigning charity compassion in care told the magazine that if a home changed name or ownership it was then listed by the cqc as "new services" and "uninspected", and there was no link to reports on the same establishment under different ownership, even if the new owners were linked to the previous owners, and there was no follow-up inspection if problems had been identified. they had found 152 homes re-registered as new, when they had only changed owner or name. the commission had identified safety concerns in more than 40% of the homes it had inspected, and 10% were rated as inadequate. in april 2016 it was reported that 44% of care homes in the south east inspected over an 18-month period were rated as inadequate or requiring improvement. only 0.9% of the 1200 homes inspected were rated as outstanding. in september 2016 the cqc said that 40% of nursing homes in the country were rated as "requiring improvement" or "inadequate". it is a legal requirement for homes to clearly display their cqc ratings on their websites, but a july 2017 survey carried out by which? found that 27% of care homes surveyed either completely failed to display them or placed them where they were very difficult to find. as of september 2018, the cqc rated almost 3,000 out of 14,975 care homes in england as inadequate or needing improvement. the care home horncastle house was closed by cqc in september 2018 as an urgent enforcement action to protect residents. in november 2018 the cqc had rated 1% of adult social care providers as inadequate, 17% as requiring improvement, 79% as good and 3% as outstanding in that year. a 2021 review of 20 care homes in england found that a good or outstanding cqc rating was associated with a better quality of life for residents. high staff wages were linked with better cqc ratings, and short-staffed homes were linked with worse cqc ratings. criticism michelle fenwick, the director of heritage healthcare franchising, complained in december 2019 that the fees charged to home care providers, which are proposed to be based on the number of clients supported, were unfair and the service was poor. it could take more than four months for a new service to be registered. she complained that assessments were too subjective. the commission has also been accused of being a barrier to innovation and impeding a shift to digital services because they insisted on paper records, and there were claims that some inspectors did not understand electronic records. winterbourne view winterbourne view was a private hospital at hambrook, south gloucestershire, owned and operated by castlebeck. it was exposed in a panorama investigation into physical and psychological abuse suffered by people with learning disabilities and challenging behaviour, first broadcast in 2011. one senior nurse had reported his concerns directly to cqc, but his complaint was not taken up. the public funded hospital was shut down as a result of the abuse that took place. cynthia bower, then the chief executive of the commission, resigned ahead of a critical government report in which winterbourne view was cited. ash court ash court is a residential nursing home for the elderly in london, operated by forest healthcare. in april 2012 hidden camera footage was broadcast in a bbc panorama exposé which showed an elderly woman being physically assaulted at ash court by a male carer and mistreated by four others. the standard of care at the nursing home had been rated "excellent." the victim was an 81-year-old woman with alzheimer's disease and severe arthritis. although the commission's primary function is to enforce national standards including safeguarding the vulnerable and "enabling them to live free from harm, abuse and neglect" the cqc responded by stating that they "should not be criticised for failing to protect people from harm" and could not be expected to spot abuse "which often takes place behind closed doors." whorlton hall whorlton hall is a private hospital in county durham which had previously been owned by the same company as winterbourne view. an undercover investigation by the bbc panorama programme found evidence that vulnerable clients with autism or learning difficulties were physically and verbally abused by staff. patients were also physically restrained. the current owners of the service, cygnet have stated that all patients have now been transferred to other hospitals. the service had been visited at least 100 times by official agencies in the year before the abuse was found out, including visits by the care quality commission, durham council and local nhs bodies. it has since been closed. a former cqc inspector barry stanley-wilkinson has alleged that he had raised concerns about a "very poor culture" at the service in 2015. stanley-wilkinson said that he worked at the cqc for a decade and that this was the only report he had written which was not published. in response the cqc stated that reports went through a "rigorous peer review process" and the draft report "did not raise any concerns about abusive practice". they also said: "we are in the process of commissioning a review into what we could have done differently or better in our regulation of whorlton hall and these allegations will be fully investigated as part of this. we will update on the progress and findings of this review in our public board meetings." on 10 june 2019 the cqc released a previously unpublished report from 2015 on the service where it was given a rating of "requires improvement." ten workers have been arrested by durham police and have been questioned about the alleged abuse and neglect of the patients. primary care in january 2015 the commission for the first time took action in respect of primary care. three gp practices were put into special measures after unsatisfactory inspection results. staffing in a report to the audit committee revealed by the health service journal in july 2014 it was reported that the commission had employed 134 applicants in 2012 who "failed some or all of its recruitment activities". of that group 121 were still in post. the report said: "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." in the same month the chief executive david behan said that recruiting extra inspectors was taking longer than expected due to the "high standards" set for new recruits. as a result, some teams were operating at 50% capacity. in response to this situation the number of inspections scheduled for the second half of 2014 was scaled back. a report of the cqc board in december 2014 showed the organisation had 852 full-time equivalent inspectors in post but a target of 1,411 by december 2015 – the number needed to "discharge the commitments that we've made in our business plan". funding the budget for 2015/6 was £249 million, but is to be reduced to £236 million for 2016/7. it is anticipated that by 2019/20 the budget will be £217 million. it had a budget of £1.1 million for "travel and subsistence" for hospital inspections in 2014–15, but actually spent £4.4 million. in response to a freedom of information request in november 2015 it was stated that cqc have a database support contract with computacenter which costs approximately £700,000 per annum; the contract expires in september 2016 with the option of a 1-year extension. substantial increases are expected in future years as it moves to a full cost recovery basis. nhs providers described the decision to increase fees as "regrettable". for 2016/7 fees will increase by 75% as its government funding is reduced by 25%. the increase in fee levels has been criticised by the registered nursing home association (rnha), care england and the voluntary organisations disability group (vodg). fees relate to the size and type of organisation and have been increased on a yearly basis: cqc fees yeargp practice on one site with 5,000-10000 patientsnhs trust, with turnover between £125 million and £225 millioncare home 26–30 residentshome care provider 2015/6 £725£78,208£761 2016/7 £2,574£136,864£4212£1,369 2017/8 £4,526£202,239£4,375£2,192 however, in october 2020 it was announced that the fees for 2021/22 would remain the same as 2019/20. the commission stated that as they are only