David Behan, the outgoing Chief Executive of the Care Quality Commission (CQC), has suggested the successful pilot of CQC care/health system reviews are put on a firm legislative footing. Whether Brexit gives parliamentary time for this in the next few years is another question, but I look at this suggestion through the prism of whether it is good for adult social care.
And I'm sorry to equivocate but...
I managed the review of performance controls on local government in the mid-noughties. We concluded that three quarters of scarce local leadership time was spend 'feeding the beast'. Audit, inspection, and statutory plans were rampant. It was out of control, and a historical lesson in what happens when you place unbridled faith in regulation to drive improvement.
Yet more widespread system reviews could help. There is no question that alongside heroic efforts by Councils and the NHS and lots of examples of breathtaking innovation, we are not developing at scale the kind of collaborative, preventive, user-focused care systems we need. In many instances, we use data badly, leaders behave badly, money is spent badly and we treat our workforce badly. Inspection could unearth these issues faster than otherwise.
But I would not support more inspection powers absent of a much clearer and more comprehensive leadership and vision in health and care - inspection becomes (partly) how delivery of that vision is assessed. We are nowhere near having the roadmap we need.
And given where we were more than a decade ago, I would put some kind of sunset provision into new inspection powers. The system probably needs the mirror of inspection, but history suggests without checks and balances, inspection can become as institutionalised as the organisations it seeks to hold to account.
The government should give the Care Quality Commission new powers to inspect and rate local health systems, its outgoing chief executive has told Health Service Journal. 375_lgc_hsj_reporting This would help drive greater collaboration between service providers, Sir David Behan said. Sir David said there was evidence the CQC’s local system reviews of 20 health economies had prompted senior leaders to work together and he said the regulator needed to change as the system itself changed.