The publication of the first Care Quality Commission ‘Market Report’ provides a timely opportunity to reflect on the value of regulation and its likely future in the wake of David Behan’s appointment as the new CQC Chief Executive. Behan will be acutely aware of the pressing need to establish a USP for the embattled regulator, and one challenge he will not underestimate is the emergence of competition in the form of the citizen advocate ever ready to offer their views and opinions about what good quality care looks and feels like.
The travails of CQC since its inception in 2009 are well documented and the appointment of David Behan points to a clear desire amongst politicians to establish a firmer grip on the scrutiny of health and social care provision. Behan’s unique leadership and management style are ideally suited to this aim, and no one at CQC will be under any illusion as to what will be expected of them from August. For the healthcare industry, those ripples will also be felt as the drift under Cynthia Bower is replaced with a steely determination and keen sense of purpose.
There is much to occupy the new Chief Executive. The government’s ‘Caring For Our Future’ White Paper, the long running saga of the Dilnot recommendations, the continuing legacy of the Panorama expose, NHS reform implementation, the salutary findings of the ‘Delivering Dignity’ report, and ongoing economic volatility and uncertainty in the care market, will all require a deft and clever hand on Behan’s part.
In his previous role as Director General for Social Care, David Behan was a key architect of the future vision for care and support, and just in case anyone had forgot, he was also the highly successful first Chief Inspector of the Commission for Social Care Inspection, a former sector regulator that the national provider representative associations now view with increasing nostalgia. If anyone is well placed to make sense of the very purpose of regulation in an increasingly challenging environment, it’s Behan.
However, in a future where anyone and everyone can inform the evaluation of care service quality, what will be the currency of the professional expert? This week’s White Paper makes clear the Government’s support for the growing community of care comparison and consumer feedback platforms that have mushroomed over the last year, and Number 10’s demand that the big corporate care providers sign up to a ‘voluntary compact’ in which performance data is published adds a further dynamic to the question.
The White Paper sets out a commitment to reintroduce quality ratings for care services, albeit in different clothes. This time the regulator will not be the ringmaster, but rather one turn in a show that is looking increasingly crowded. CQC’s inspection findings will form just one part of an overall assessment of care service quality that will embrace a broad range of data, information, views and experience shared by service users, carers, commissioners, providers, and the general public. The introduction of Healthwatch will enable Behan to exert some additional leverage into the mix, but he will want to clearly mark out the unique value of CQC’s contribution.
The irresistible momentum to democratise choice and promote universal involvement in health and social care decision making presents new challenges for all professionals. Many inspectors who have navigated the story of regulation from its local beginnings to the monolithic CQC bemoan the gradual loss of a distinct professional identify and a dumbing down of their role. Whilst I have no doubt they would unreservedly embrace the benefits that lay people and others bring to the process (such as the CSCI developed and CQC adopted ‘Experts by Experience’ programme) there remains strong reservations within the Commission as to how that experience is used.
A key worry for a number of regulatory professionals is the question of what constitutes ‘evidence’. An inspection can establish on any given day the compliance of a care service with the Essential Standards, and the inspector is able source the evidential materials and other information required to reach that determination. The bar is set high for sound reasons, and the knowledge that you could end up at a Tribunal if you act unethically or negligently is a powerful motivator for getting it right.
However, where the views of other stakeholders are concerned, it is at present simply sufficient for them to express a generalised concern about the quality of care for it to be accepted as wholly justified. This is particularly so where local authority commissioners, families and carers, and others with a sufficient interest in the health and well being of service users are concerned. Many inspectors believe the lack of any real interrogation and validation of such experience, along with an absence of ‘weighting’ to place these concerns in a balanced context, represents a significant flaw in the design of the existing regulatory model.
It is one thing to have an impression of a care service based on a personal, often subjective and sometimes partial experience, as opposed to independently evaluating what is found through methodologies and techniques developed over time to clearly separate tangible fact from unproven opinion. Behan will need to restore confidence in a workforce that largely feels regulation has lost its way, and who will eye the government’s commitment to a brave new world in which the regulator is no longer the definitive arbiter of quality, as an uncomfortable step into the unknown.
It is essential that people’s experience of care and support is reflected in the assessment of provider quality and (subject to effective moderation to ensure that the opportunity for comment is not abused or misused) there is a broad based consensus that a reformed social care system must be open, transparent and accessible to a wide community of interests.
The ‘Find Me Good Care’ platform to be launched this autumn by the Social Care Institute for Excellence (SCIE) will see a credible heavy hitter enter the online rating and consumer feedback market place, and indications are that CQC has already seen the potential benefits of closer collaboration with a sector brand that is both trusted and respected. How quality ratings will be articulated and presented currently remains unclear, but one senses that Behan will be keen to ensure that the continuing value of regulation and the role of the professional expert is reflected in the eventual solution.
Steve Carney is a creative innovator with over three decades experience and a well respected national profile in the health, social care and alternative dispute resolution fields. Steve has made significant contributions to the development of public service policy and quality improvement in service delivery though his many achievements in a number of high level strategic posts.
These have included the positions of Deputy Ombudsman at the Scottish Public Service Ombudsman, National Head of Complaints & Service Improvement with the Commission for Social Care Inspection, and Complaints Policy & Project Manager at the Department of Health. Steve has also represented the complaints profession during his time as the Chair of the National Complaints Managers Group, and been a regular contributor to a wide range of Government sponsored working parties. He is an experienced public speaker and has a first class reputation as a motivator and team performance coach.
Steve is currently providing business development expertise and knowledge to Care Quality Consultancy Services, a specialist company providing professional regulatory compliance and improvement services to healthcare providers. Most recently he led a major review and implemented a new business model at the Scottish Public Services Ombudsman. During his time in Scotland he also contributed to the development of landmark No Fault Compensation policy for the Scottish Government. Between 2004 and 2009, Steve was a senior professional at the Commission for Social Care Inspection, and during his time with the social care regulator he was a member of the CSCI Leadership Group, implemented a national quality ratings review policy and service, and made key contributions to the Inspecting for Better Lives reforms. Steve has also authored DH policy, procedure and practice guidance.
Steve’s contact details are: http://uk.linkedin.com/pub/steve-carney/24/774/34