Care Quality Commission chief executive Cynthia Bower has vowed it will not neglect social care, in an interview with Community Care to mark the health and adult care regulator’s full establishment today.
Bower acknowledged that the impact of the public profile of the NHS on the regulator’s priorities was an issue for the CQC, which has replaced the Commission for Social Care Inspection, Healthcare Commission and Mental Health Act Commission.
She said: “There will be headlines about the NHS as it’s an iconic British institution. But I’m absolutely confident that we’ve got the people in the organisation who have got the passion [for working across health and social care], not least [chair] Barbara Young.”
Platt’s health warning
The claim follows a warning from outgoing CSCI chair Denise Platt that the new regulator may be driven by events to focus on health at the expense of social care, despite Bower and Young’s best intentions.
Platt also warned that the CQC lacked people with social care expertise at senior level besides Bower, who joined the NHS in 1995 after a 19-year career in social care.
Bower acknowledged that the CQC had no executive directors, besides herself, with a social care background, three having come from the Healthcare Commission and the fourth from outside both care sectors.
Most staff from CSCI
However, she pointed out that most of the CQC’s staff had transferred from CSCI, all of its firstline managers were from a social care background and there was an even split of health and social care managers in the rest of the organisation.
CQC has also appointed former Mencap chief executive and Association of Directors of Social Services president Jo Williams as a commissioner on its non-executive board, along with Olu Olasode, who performed the same role at CSCI.
With three vacancies still to fill at executive level, the most important being director of operations, Bower added: “I will do my absolute best to see that we get someone from social care for that. The two deputy directors of operations are from a social care background, as is my chief of staff. I feel social care is embedded in the organisation.”
User involvement challenge
Platt also challenged CQC to take up and further develop CSCI’s focus on service user involvement, for instance through the Experts by Experience programme, through which users have taken part in inspections.
Bower highlighted the fact that CQC had inherited CSCI’s head of user involvement, Frances Hasler, and that it will continue with Experts by Experience. A statement on its user involvement plans is due shortly.
She added: “What you will see is a commitment beginning at board level to have user engagement in everything that we do. We want to take the habit that CSCI has developed that, whatever you are doing, think about how people who use services can be inspected.”
State of social care reports
Another area where CSCI made a big impact, according to Platt, was through its annual State of Social Care reports, which she said had shaped social care policy.
Notably, the 2008 report’s focus on the poor experiences of those denied publicly-funded adult social care led the Department of Health to promise to review guidance on eligibility criteria.
Bower said CQC had initially thought about issuing a fully integrated annual report on health and social care, but had now “realised that might not be the best way of doing it”. Instead, it is likely to produce a single report with separate health and social care sections, and a thematic review looking across both.
Policy impact important
Bower said making an impact on policy would be an important goal for CQC, adding: “It’s about saying that as a regulator, ‘this is what we’ve gleaned through inspection and regulation and this is what we think the policy should be’. The regulator’s credibility comes from being a very robust and independent observer who looks very hard at services.”
While Platt raised questions about CQC’s independence, Bower said: “I’m absolutely confident about our independence. That comes from having very strong commissioners and a very strong chair in Barbara. I think that the DH knows it needs a strong and independent regulator. We give reassurance to the public in a way that no one else can.”
Staff concerns over CSCI quality
Bower also addressed past concerns from CSCI staff about the former commission’s introduction of a risk-based system of provider assessments, with inspections focused on poorer services and a greater use of self-assessment.
This means that providers given three stars in CSCI’s quality ratings can be left without an inspection for three years, which has led to concerns about the quality of assessments from staff in successive surveys by Unison and CSCI itself.
Review existing approach
Bower said: “Over the next 12 months we will take our own view of that. One thing I’m fairly sure is that we will continue to be a proportionate and risk-based regulator.”
However, she added: “No doubt as time goes on we will change our inspection process. We want staff to feel that they are engaged when processes change and that they’ve been a part of that.”
Mental Health Act Commission
She said the Mental Health Act Commission’s function, to monitor the welfare of patients detained under the Mental Health Act, would continue as a “discrete element” within the CQC, with its own manager.
During the passage of the Health and Social Care Act 2008, which set up the CQC, ex-MHAC chair Kamlesh Patel raised concerns over whether the watchdog’s system of visiting 6,000 detained patients a year in wards would be maintained.
Bower said the system would stay the same though it would be reviewed over the next 12 months. She added; “MHAC has been an extraordinarily successful organisation. It’s a very human rights-driven organisation. You change that at your peril.”