New Care Quality Commission watchdog quango pleads for patience

The new watchdog for health and social care called on politicians to put an end to a decade of regulatory turmoil in hospitals and social work.

The Care Quality Commission, which opened last week, is the third new quality regulator for health, and the fourth for social care, in only nine years.

“To lose one regulator is unfortunate, to lose two is downright careless – and to lose three would be pretty criminal in my view,” said Lady Young, its chairman, in an interview with the Financial Times.

The new CQC opens its doors only weeks after Mid-Staffordshire hospital was granted flagship foundation trust status by one regulator, during an inquiry by another that revealed “appalling” standards of emergency care. The Baby P case last year, in which a young London child died after dreadful neglect, raised serious concerns about the regulation of social care.

Lady Young, a former National Health Service manager who came to the CQC from the Environment Agency, which regulates everything from car scrap dealers to nuclear power stations, said the new, combined watchdog needed time to prove itself.

“Good regulators develop a track record,” she said. “We need a bit of time, 10 good years at least – preferably longer. Not for me but for the organisation”, she said.

“Look at the Audit Commission . . . They have tackled a whole range of new jobs, they have been flexible, they have been adaptive and they have done a good job generally. They know how to do it. They develop a track record.”

The new commission will be different, she said, not least because it will embrace both health and social care, along with the supervision of detained mental patients, in one organisation. Given the risks that more members of an ageing population will fall through the cracks between health and social care services, that had to be right, she said.

But, after the regulatory failure at Mid-Staffordshire NHS Foundation Trust, there will be other changes too, she said.

Mid-Staffordshire was granted foundation trust status by one regulator, Monitor, in the middle of the inquiry by another, the Healthcare Commission, one of CQC’s predecessors, that found “appalling” standards of emergency care from which, the commission said, patients died.

As well as the two bodies failing to communicate, the hospital’s services were rated “fair” – barely adequate but not dangerous – for two years during which, concluded the commission, patients had suffered and died.

A fresh data analysis technique to examine high death rates that will continue to be developed by CQC, eventually picked up the problem.

But as in the case of Baby P, where Ofsted rated Haringey’s social services as “good” at the time the child died, “that does raise questions about the balance between clever use of data and inspection,” Lady Young said.

“We need to get the balance right between data and inspection – and we will be out there sniffing the breeze, being on the ground and eyeballing staff and patients.”

A good regulator is there “to nip problems in the bud,” she said. A host of fresh data about the quality of care is on its way, which the commission will share, and which ought to make that easier.

But Lady Young warned against the current trend – “which is: when things go wrong, blame the regulator”.

“We do need to highlight where responsibility lies for the provision of quality care,” she said. First with doctors, nurses and care workers on the ground. Then with boards of organisations. And then with those who commission care and performance – manage the systems. The commission will provide independent oversight, information that will help address quality, and assurance, she said.

But “it will be a failure of the service if the management [does] not get to quality issues before we do”.


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