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The Care Quality Commission has been a disaster, but we still need regulators The Care Quality Commission has been a disaster, but we still need regulators
(3 months later)
The revelations about the role played by the Care Quality Commission (CQC) in monitoring and regulating the University Hospitals of Morecambe Bay NHS foundation trust have caused yet more damage to public confidence in one of the nation's best-loved institutions, the NHS.The revelations about the role played by the Care Quality Commission (CQC) in monitoring and regulating the University Hospitals of Morecambe Bay NHS foundation trust have caused yet more damage to public confidence in one of the nation's best-loved institutions, the NHS.
It is very easy to understand why. Earlier this year we had the long-awaited report of the inquiry into Mid Staffordshire NHS foundation trust. The shocking stories of appalling levels of "care" and downright neglect in parts of that trust had already been harrowing, even to the most hardened cynics and those of us, like those in my charity Action against Medical Accidents (AvMA), who hear every day of lapses in patient safety causing serious injury and death.It is very easy to understand why. Earlier this year we had the long-awaited report of the inquiry into Mid Staffordshire NHS foundation trust. The shocking stories of appalling levels of "care" and downright neglect in parts of that trust had already been harrowing, even to the most hardened cynics and those of us, like those in my charity Action against Medical Accidents (AvMA), who hear every day of lapses in patient safety causing serious injury and death.
We know from our personal lives that the vast majority of people who use the NHS still receive amazingly good care. However, the extent of the normalisation of appalling treatment and neglect at Stafford and the deep-seated culture of cover-up, bullying and denial were things that we never thought we would see. Yet, we told ourselves good can come from even the worst disasters. The system would learn from this and things would begin to be put right. We did not need the public inquiry report to tell us that things needed to change. The inquiry might give us a road map of the way forward, but there had already been numerous revelations about how bad things had got.We know from our personal lives that the vast majority of people who use the NHS still receive amazingly good care. However, the extent of the normalisation of appalling treatment and neglect at Stafford and the deep-seated culture of cover-up, bullying and denial were things that we never thought we would see. Yet, we told ourselves good can come from even the worst disasters. The system would learn from this and things would begin to be put right. We did not need the public inquiry report to tell us that things needed to change. The inquiry might give us a road map of the way forward, but there had already been numerous revelations about how bad things had got.
One of the most shocking things about the scandal concerning Morecambe Bay and CQC's role in regulating that trust is that it was allowed to happen after the full horror of Stafford.One of the most shocking things about the scandal concerning Morecambe Bay and CQC's role in regulating that trust is that it was allowed to happen after the full horror of Stafford.
Hearing how senior figures at the CQC not only failed to deal with known concerns about the standard of care at Morecambe Bay, which was resulting in unnecessary deaths of babies and others, but sought to cover up findings about its own failings even after Stafford, is hard to take.Hearing how senior figures at the CQC not only failed to deal with known concerns about the standard of care at Morecambe Bay, which was resulting in unnecessary deaths of babies and others, but sought to cover up findings about its own failings even after Stafford, is hard to take.
An understandable reaction is to say to hell with it, regulation does not work. Let's get rid of the CQC. However, be careful what you wish for. Regulation per se fits uncomfortably with the ideology of some parts of the current government. To some people regulation is all red tape and bureaucracy. It gets in the way of business, competition and innovation. An excuse to get rid of it altogether and rely instead on the forces of competition, commissioning and contracts in the unevidenced, but ideologically driven, belief that these are what really drive quality may be very convenient.An understandable reaction is to say to hell with it, regulation does not work. Let's get rid of the CQC. However, be careful what you wish for. Regulation per se fits uncomfortably with the ideology of some parts of the current government. To some people regulation is all red tape and bureaucracy. It gets in the way of business, competition and innovation. An excuse to get rid of it altogether and rely instead on the forces of competition, commissioning and contracts in the unevidenced, but ideologically driven, belief that these are what really drive quality may be very convenient.
You could get rid of the CQC and leave it all to the new system overseen by the government's latest creations, clinical commissioning groups (CCGs). Far-fetched? Maybe not. Look, for example, at how the government originally planned for a "duty of candour" – the fundamental ethical and quality standard about being honest with patients when harm is caused – to work. It was not to be statutory and regulated, but be merely a standard clause in contracts between commissioners and providers. That financial relationship would be what would change culture, we were told. It is not a huge leap from that to say that all fundamental standards could be upheld through the commissioning and contracting process, if that is your ideology.You could get rid of the CQC and leave it all to the new system overseen by the government's latest creations, clinical commissioning groups (CCGs). Far-fetched? Maybe not. Look, for example, at how the government originally planned for a "duty of candour" – the fundamental ethical and quality standard about being honest with patients when harm is caused – to work. It was not to be statutory and regulated, but be merely a standard clause in contracts between commissioners and providers. That financial relationship would be what would change culture, we were told. It is not a huge leap from that to say that all fundamental standards could be upheld through the commissioning and contracting process, if that is your ideology.
I for one think that would be a disaster. The CQC thus far has been a disaster itself. However, we should avoid throwing the baby out with the bathwater. There is a new leadership in place and they have shown encouraging signs of genuinely wanting to turn the regulator into an effective, reliable and honest one. Regulation should not be allowed to become politically incorrect. Effective regulation is not bureaucracy – it is about saving lives. We do not want more regulation but we do need better regulation.I for one think that would be a disaster. The CQC thus far has been a disaster itself. However, we should avoid throwing the baby out with the bathwater. There is a new leadership in place and they have shown encouraging signs of genuinely wanting to turn the regulator into an effective, reliable and honest one. Regulation should not be allowed to become politically incorrect. Effective regulation is not bureaucracy – it is about saving lives. We do not want more regulation but we do need better regulation.
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