One of the big themes of Keir Starmer’s government could well end up being accountability in the public sector, which sounds boring until you look at examples of where that is sorely lacking.
Take the Care Quality Commission (CQC), the NHS regulator. Today, Health Secretary Wes Streeting declared it ‘not fit for purpose’ after an interim report found some hospitals had never received a rating, that others hadn’t been reinspected for up to ten years, and that some inspectors seemed to have even less experience of healthcare settings than the average member of the public. That included inspectors who had never been in a hospital before, and ‘an inspector of a care home who’d never met a person with dementia’. No wonder providers had been complaining for a while about the inspection regime.
The CQC itself admitted last month that ‘the way we work is to working and we are not consistently keeping people who use services safe’, so this review has not come as a surprise to the healthcare world. MPs have been raising concerns about the CQC missing scandals or failing to inspect trusts for years, too. But it is still striking to hear Streeting saying the public should taking the ratings the regulator produces with ‘a pinch of salt’.
In fact, the report suggested many NHS organisations had been taking the CQC’s findings with a pinch of salt for a while. It pointed out that the executive team ‘is largely drawn from the social care sector with a noticeable lack of healthcare experience’, and that this ‘results in providers not trusting the outcomes of reviews and not feeling they have the opportunity to learn from others, especially from highly regarded peers’. Its assessment framework had ‘no description of what “good” or “outstanding” care looks like, resulting in a lack of consistency in how care is assessed and a lost opportunity for improvement’. Many of the scandals of recent years, inside and outside the healthcare system, have been prolonged by a lack of accountability and a regulatory regime which didn’t do the job it was supposed to. Governments often talk big about scrutiny in their early years, and then start to tolerate regulators going off the boil as it is inconvenient to have your own mistakes highlighted.
Jeremy Hunt was very hot on scrutiny and patient safety when he was health secretary, and Streeting has similarly been keen to be the patients’ champion, pushing back against a system that often organises things for its own convenience. But at some point, it also becomes convenient for a government to have a weak regulator: the challenge for Streeting is to ensure the CQC is sufficiently well-reformed that this opportunity doesn’t arise for his party in a few years’ time.
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