The need to regulate the regulators with a little more compassion

 Reading Friday’s news regarding the Care Quality Commission (CQC) took me back almost 24 years, when I became a reviewer for the Commission for Health Improvement (CHI). I can vividly remember the selection process. It was an assessment centre held over two days. It was one of the toughest, (but most enjoyable) assessment centres I have taken part in. I recall there were a great number of applicants; most were drawn from the NHS.

I was appointed and during the three years that I worked with CHI, I undertook four organisational reviews, all in mental health organisations. These were usually carried out over a week, and the process was very intense. Every organisation was required to submit a range of written evidence on their services. More often than not, reviewers were given a telephone directory of information to read and make sense of. As well as observation, much of the work in each review was carried out by interviews.

The interviews were semi-structured; that is to say we had a range of set questions that everyone was asked, but there was always an opportunity to probe further should something emerge that was worth following up. The interviews and observational visits were aimed at gathering evidence around: patient involvement, clinical audit, education and training clinical effectiveness, use of information, risk management and staffing and management. There were two other overarching areas of enquiry: the patient experience and the organisation’s strategic capacity for developing and harnessing clinical governance.

Each interview was taped. At the end of each day the tapes were sent in a digital format to a company in New Zealand who transcribed and returned the transcripts the following morning. These were analysed and provided an opportunity to look for triangulating evidence. This was an important aspect of the review. Every concern or example of good practice required three different bits of evidence, before it was included in the eventual report.

Every day started early and ended late. However, we were well looked after. I like to think that, although there was a little bit of ‘learning while doing’, the outcomes of each review did make a difference. As a qualitative researcher, the use of narrative, stories and observation to counterbalance the hard statistical information was most welcome. CHI was disbanded in the Spring of 2004. After a couple of variations on a CHI theme, in 2009, the CQC became the regulator for health and social care services.

I found it interesting that in the early days of the CQC, many familiar names were to be found sitting on its Board. I try and steer clear of politics, but just Google ‘CQC’ (there are other search engines), look at the names of some of those involved in those early days and then revisit my blog posted the other week. I do wonder if the CQC troubles of today were seeded all those years ago. Just a thought. I have only ever been a recipient of CQC reviews. The outcomes have not always been good. Indeed, this year the CQC have undertaken many reviews into my current Trust, most of which have highlighted there is significant work to do to improve our services. For many of my colleagues, who do work hard at trying to improve our services, such an outcome can be incredibly demotivating and upsetting, particularly when folk have lost their trust in the whole review process. On several occasions, the CQC reports simply do not reflect the organisation I see and know.

Like many others, I have raised concerns about the current CQC review process. My concerns mirror many of those noted in Dr Penny Dash’s interim report published last Friday. The current (in a long line of…) Secretary of State for Health and Social Care described the CQC as not being ‘fit for purpose’. I would agree with his assessment. However, my thoughts are with all those folk that work for the CQC and/or undertake reviews.

Being part of a regulatory body is always going to be hard. I know that from my CHI experiences. The very public condemnation and excoriation of the CQC does not fill me with joy or delight. There are people involved here that are just like you and me. Many of them will be devastated  by this description of their organisation and work. So, if you know someone who works for the CQC or might be one of their reviewers, please show some compassion, reach out and be there for them at this challenging time. It’s time to care, not simply judge.