The future shape of healthcare regulation
Breakfast Seminar - 23 June 2009
Speaker: Baroness Young, Chair of the Care Quality Commission
The sixth Care Conversation event heard the views of Baroness Young, Chair of the Care Quality Commission (CQC), on the future shape of regulation
‘Quality of care is improving,’ Baroness Young told delegates. ‘More standards are being met by more organisations.’ This, however, masked a huge range of quality and delivery, she said. There was still substantial geographic variability in access to local authority-funded care, and while there was less of a postcode lottery in healthcare, true equality of access was still a long way off.
This was the challenge faced by the Care Quality Commission (CQC), which came into being in April, replacing three separate organisations. It was determined to be new and distinctive, she said, and put service users and their families at the forefront of its work.
‘We are the only health and social care regulator in the world,’ she told the seminar. ‘We want to make sure services are joined up, and we want to be responsive and flexible.’ High profile cases like Baby P and the Mid Staffordshire Foundation Trust represented a failure in the regulatory system, and it was essential to have mechanisms in place to spot potential future performance problems, she stressed.
The CQC would be no good to the public unless it was ‘thought-through, evidence based and truly independent’, she said. It would celebrate good practice and be genuinely collaborative and open, while focussing on value for money, access to services and patients’ experience of those services. It would also address poor performance, paying particular attention to the bottom 10 per cent.
One of its main regulatory tools was the registration system, spanning all health and social care – public and private – including, from next April, the NHS, she said. The intention, however, was not to make things excessively burdensome for those already registered. ‘The challenge is how to do it in a way that is ‘light touch’ and appropriate – that really helps quality and is not just a bureaucratic exercise.’
The registration system would focus on the experience of those using the services and their families, she said. ‘We want to focus on outcomes and not be prescriptive. It won’t be one size fits all – it has to span a huge range of services and providers.’ Service users would be involved in governance and deciding priorities, with the CQC sharing information and working closely with service user groups. ‘The input of service users is vital,’ she said. ‘They bring questions to the regulatory process that a regulator who hadn’t used the service would not.’
The Commission was determined to be a ‘modern regulator’, she told delegates – ‘proportionate, risk based and working hard to reduce regulatory burden.’ It would also work to ensure a level regulatory playing field. ‘We can be very consistent but there are a myriad different providers, so we have to be flexible to reflect that.’ A provider advisory group would ensure close working, she said.
Innovation on the part of providers would need to play a key role in healthcare provision in the light of the economic squeeze, she stressed. ‘So if you find us being dogged rule book readers, complain – because we don’t want to be like that. We want to be a thoughtful partner – we will be less tick box, but you need to keep challenging us so we know how it feels to you.’
Quality would be the CQC’s organising principle, she promised, and given the large number of organisations with a regulatory function, there was also a real need to get alignment into the system. Finally, she made a plea for government to resist restructuring. ‘It would be a disaster if we started changing the shape of regulation again. Give the regulator ten good years to get the process going, work with providers and assure the public that work is going on to ensure quality of care where they receive it.’