At Gloucestershire LINk’s Annual General Meeting on June 16, Ian Biggs of the Care Quality Commission (CQC) gave a talk and answered some questions. He is the CQC’s South West Regional Director, and in addressing the LINk so soon after the CQC had been shown up by a BBC Panorama investigation into a care home near Bristol, he had a rather bumpy ride.
It did not help Mr Biggs, I thought, that his rather frightened appearance and vacuous turn of phrase rather made him seem like a thinner version of Ed Balls. He was too fond of empty slogans like:
putting people at the centre of what we do
And he too often tried to make bland corporate-speak sound believable by a thin pretence of personal involvement:
through regulation I think we can drive improvement
On the abuse that Panorama made public, he declared that the CQC:
could have acted more quickly
However, any grasp of what really went wrong or why was conspicuous by its absence.
The rest of his presentation was entirely dull. I cannot bring myself to write about it.
Audience members asked several questions, and mostly he waffled tediously, only sometimes making a serious point. Determining the treatment provided for fibromyalgia, he said, was not the CQC’s job. When asked about domicilliary care, he changed the subject to talk about unregistered carers. A few questions were more interesting, though.
Asked about CQC funding, he said that it is likely to move towards being provided by the care providers who are being regulated. This means that instead of being a visible government grant it will become invisible, hidden in the accounts of thousands of providers. However, the silver lining in this cloud is that when care providers are paying for the service they will sooner or later start to demand an efficient, effective service and a choice of local providers. The writing is on the wall for the CQC in its present form.
In a discussion of the CQC’s review of Gloucester Hospital it was revealed that the managers there welcomed the inspections. It was confirmed that the managers had also welcomed the LINk’s recent inspections there. While that sounds nice, it suggests that hospital managers are not doing their own quality assurance, but leaving it to external agencies.
Ian Biggs spent a lot of time claiming that the CQC value people, emphasizing how much importance they place on talking to a range of people whenever they carry out an inspection. The problem is that they only value people superficially. They don’t look deeper at the systems in place, and at the way services are managed.
That’s why no matter how many inspections the CQC carry out, their net effect on care quality is likely to be to undermine it. The CQC does not seem to understand that there is a balance of benefit and risk in outsourcing quality to a national quango. The PR is all about the benefit, and spokesmen like Ian Biggs are all about the PR. The risk gets hidden.
Forced to acknowledge the CQC’s limitations, he finally admitted them:
We cannot be there all the time.
We are not a guarantor of safety.
LINks have enjoyed a peaceful co-existence with the CQC, because they are all in the same line of business. As LINks evolve towards HealthWatch, I think this is bound to change.
The CQC’s inherent limitations, the limitations of the regulatory model it imposes, set the CQC against the public’s need for safety to be guaranteed all the time. HealthWatch, as the “consumer champion” will be bound to champion what the public needs, and what the CQC cannot deliver. It should be interesting.