Quality Checkers are the Future of Regulation

Author: Sam Sly

A version of this article was first published in Learning Disability Today.

The National Care Standards Commission (NCSC), the Commission for Social Care Inspection (CSCI), and the Care Quality Commission (CQC) - the changing face of the regulators that govern health and social care. Having been inspected recently, and worked for the NCSC and CSCI for six years from the inception of NCSC in 2002 I watch the changes, wince at the failures and where possible try to defend some of their actions because when the NCSC started it was full of hope and there was some good, ground breaking work.

I have been frustrated lately by the comments of the new CQC Chief Inspector of Adult Social Care Andrea Sutcliffe who has started talking of ‘a fresh start’ for CQC. I sometimes wonder whether CQC really believe that reinventing themselves makes people forget all that has gone before. I just see the wasted public money being ploughed once again into another transformation to the ‘same old same old’. 

That aside the thing that frustrates me the most though is that much of what Sutcliffe talks about as a ‘fresh start’ was happening and developing nicely when the regulator was the NCSC and CSCI for example experts by experience and yearly inspections. However, the dedicated central User and Public Involvement team that were doing amazing work with interested Inspectors around the Country was disbanded.

Another innovation that was designed to give regulators professionalism and would have given the public confidence and regulation consistency was the Regulation of Care Services Award (RCSA).

The RCSA was going to be the NCSC standard qualification for all Inspectors. All Inspectors were going to have to do the diploma/post degree level qualification on joining the Organisation. 

Regulation isn’t taught on social and health care courses as standard, so other than ‘on the job’ training each Inspector is left to ‘interpret’ the job, standards and regulations becoming more confident with experience. Inconsistency of inspection and rating between Inspectors was one of the things that worried Providers, and to be truthful Inspectors. 

The RCSA was an excellent distance learning course provided by Anglia Ruskin University, and I snatched at the chance to do it being one of the forty so Inspectors in the first year nationally to complete the two year course and achieve the qualification. I was also fortunate enough to then be able to do the offered Masters in the regulation of health and social care. By this stage I felt much more confident in a professional regulator and was able to contribute to the development of the Organisation as well. 

The RSCA was then axed. It was decided that the course or concept was not necessary and only two intake years ever happened – I believe less than a hundred Inspectors ever completed the course. I think this was a huge mistake. 

Other things that the NCSC were doing, and thought worked well were also axed as the way we regulated was turned on its head time and time again. For example:

• We had a caseload of Providers that we kept year on year so that the residents/people supported got to know us, and us them. This was especially useful for people with learning disabilities whose communication was complex or who took time to trust people. 
• We Inspected at least yearly, often much more and our pictures and contact info was left in the home.
• We sent out questionnaires and contacted families, professionals and staff before inspecting so we had a good knowledge of what was happening before we visited.
• We inspected Providers of services that matched our professional and past experience – for me that was services for people with learning disabilities and mental health needs. We were therefore more confident and could keep up to date with current practice in our field.
• For the short time that we were the NCSC we had the ability to support providers with information, sign-posting and put them in touch with other providers to support one another instead of the current regulatory approach of ‘you are not good enough go away and sort it out yourself’.
• We had offices and did not do remote working as they do now. This meant that we met each other regularly, we could share intelligence, discuss and map concerns, learn from one another.

I am not saying everything was a bed of roses in fact I questioned the place of regulation on a daily basis. I left in the end because I became disillusioned about the lack of ‘teeth’ the regulator had to stamp out poor practice.

I suppose at the end of the day the big question is not do we need another ‘fresh start’ for CQC? But do we need this type of regulator? Is it making a difference and do we feel assured that our loved ones are getting the best quality of care and support they require? 

With the imminent launch of the National Association of Quality Checkers (NAQC) - the newly affiliated national body for self-advocate learning disabled led quality checker organisations - I know where, given the choice, I would spend the money I currently do on regulation. I would pay these people that have the experience, empathy, skills and hands on experience of the systems we have created every time. Good luck NAQC you are the future.

The publisher is The Centre for Welfare Reform.

Quality Checkers are the Future of Regulation © Sam Sly 2014.

All Rights Reserved. No part of this paper may be reproduced in any form without permission from the publisher except for the quotation of brief passages in reviews.