The Care Quality Commission

Any premises where people are cared for are monitored by the Care Quality Commission, which exists to look after the interests of service users. A clean environment is vital in these settings and this includes having high air quality, so that people are not exposed to airborne infection or other airborne contamination. Cleanliness is one of the Standards which the Commission will inspect for so, to ensure compliance, it may be sensible to take effective steps to improve air quality.

The Care Quality Commission (CQC) is a 'watchdog' organisation. It defines itself as 'the independent regulator of health care and adult social services in England'. It covers services provided by the NHS, and local authorities, as well as those that are provided by private or voluntary organisations. The main aims of the CQC are:

- Identifying risks to the quality and safety of people's care - Acting swiftly to eliminate poor-quality care Making sure care is centred on people's needs

The CQC operates through a registration scheme, whereby registered organisations have to comply to set standards. The Commission checks that standards are being met through inspecting registered premises. If standards fall short, the CQC has a wide range of powers to make sure things are put right.

The CQC has detailed guidance on its website in its document Essential Standards of Quality and Safety.Essentially,
the guidance turns the legal regulations into outcomes – that is, what
people should experience when the standards are being properly adhered
to. Each of these outcomes is followed by prompts which help a
registered organisation to think about whether, and how, the desired
outcome is being met. The CQC points out that people don't have to
follow their guidance –they are free to use their own methods to monitor their compliance with the standards.

The CQC inspectors use an enforcement policy and a judgement framework
to decide what action to take when standards are not being met. These
actions are always followed up. If changes and improvements are not
made, then action can be escalated - to the extent of insisting an
organisation is closed down until compliance is achieved. In other
words, the CQC is a watchdog that has teeth!

Yes, of course, the CQC Standards refers to 'Cleanliness and hygiene', which includes airborne hygiene needs. Service providers have to have good procedures for cleanliness and infection control and service users must be protected from the risk of acquiring so-called healthcare-associated infections, which include the notorious Clostridium difficile and methicillin-resistant Staphylococcus aureus, as well as norovirus. Such pathogens can become airborne, when someone coughs, sneezes or vomits generating an infectious aerosol. This may be inhaled directly or settle on a surface, thereby contaminating it.

All providers who are registered with the CQC must follow the Department of Health's Code of Practice for health and adult social care on the prevention and control of infections and related guidance. There are many aspects to cleanliness and infection control, including:

  • Hand hygiene
  • Isolation rooms, which may require ventilation modifications (negative or positive pressure, depending on whether others need to be protected from the patient, or the patient needs protecting from others)
  • Deep cleaning of surfaces and objects
  • Training/education and a culture of cleanliness and hygiene among all grades of staff


The signs are that, on the whole, the hygiene message is being heard and acted upon. In 2011-12, CQC inspections revealed that 91 per cent of NHS hospitals, 90 per cent of community healthcare services and 96 per cent of mental health, learning disability and substance misuse services met the required standard for cleanliness and infection control.

In a case study, CQC notes that BMI Healthcare performs particularly well when it comes to infection prevention and control. The company has ensured that all of its 64 hospitals have appropriate resources and well-trained staff to maintain high standards. For instance, all BMI hospitals carried out a self-assessment and established plans to move towards an objective of moving towards a minimum number of infection control specialists across the group. BMI has also registered with the World Health Organisation's global challenge of continual improvement in hand hygiene with the goal of continual and sustained improvement.

The CQC covers (in England):

  • All hospitals
  • Over 18,000 care homes
  • Domiciliary care services
  • All primary dental care services (private and NHS)
  • GP practices and other primary care services
  • Secondary and specialist healthcare services


Another way of looking at the remit of the CQC is by activity. You need to register with CQC if your business involves any of the following:

  • Personal care
  • Accommodation for people who require nursing or personal care
  • Accommodation for people who require treatment for substance misuse
  • Treatment of disease, disorder or injury
  • Assessment or medical treatment for persons detained under the Mental Health Act 2008
  • Surgical procedures
  • Diagnostic and screening procedures
  • Management of supply of blood and blood-derived products
  • Transport services, triage and medical advice provided remotely
  • Maternity and midwifery services
  • Termination of pregnancies
  • Services in slimming clinics
  • Nursing care
  • Family planning services

Most hospitals, care homes and care home agencies are inspected at least once a year and dental services are inspected at least once every two years. Inspections are usually unannounced and fall into one of three categories:

  • Regularly scheduled inspections
  • Responsive inspections -carried out when concerns have been raised over an organisation's standards
  • Themed inspections - where a particular type of service or a specific set of standards is reviewed


After the inspection, the CQC inspector will judge the provider as being either compliant or non-compliant with the regulations. If non-compliant, the inspector judges whether the infringement has a minor, moderate or major impact on service users and it is this which guides the action that is then taken.

Yes, they can. And they can do this anonymously if they are concerned about the impact of their whistleblowing activity.