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Behan: all managers should spend time at CQC

NHS managers should see a stint working at the Care Quality Commission as “an essential part of their career”, the regulator’s new chief executive has told HSJ.

In his first interview since taking up the post at the beginning of July, David Behan told HSJ this would benefit the CQC by bringing people with relevant experience into the organisation but also help managers learn “what good looks like”.

Mr Behan spoke to HSJ following the launch of a consultation on the regulator’s strategy for 2013 to 2016 and the day before CQC chair Jo Williams announced her resignation.

The strategy proposes a move back towards the sort of a more risk-based approach abandoned by Dame Jo and former chief executive Cynthia Bower a year ago when they committed to inspecting most NHS providers and care homes at least once a year. The move followed high profile public criticism of the CQC’s performance by the health select committee.

The new strategy proposes adopting a “differentiated” approach to regulating the three sectors CQC is responsible for – health, social care and mental health. It acknowledges the current commitment to annual inspection is unlikely to be sustainable.

Asked whether Ms Bower should have stuck to the original model, Mr Behan said her approach had been right at the time.

“What Cynthia did was develop CQC and get it started. She had the job of registering all services and that’s a contribution that Cynthia made.

“What this strategy is signalling and I am signalling is we’re now moving into a different phase.”

Mr Behan, who started his career as a social worker and was previously the Department of Health’s director general of social care, said it was important to be “unambiguously clear” that the CQC would still inspect all providers and carry out unannounced inspections.

However, he said the CQC’s emphasis was now on developing a model of regulation that made greater use of evidence, particularly information from patients and service users.

Mr Behan said more information was needed on how effective the CQC’s interventions were at bringing about service improvement. He revealed the regulator was commissioning an academic evaluation of its actions.

The CQC has been criticised by many, including the NHS Confederation, for a lack of consistency in its inspectors’ judgements. Mr Behan said questions over the expertise required by inspectors and how many inspectors were needed still to be answered. However, he suggested the CQC’s make-up could change dramatically.

“My vision for CQC is of an inspectorate where any successful manager in the health and social care sectors will see working at CQC for a period of time during their careers as an essential part of their career,” he said.

“If I look at my own career I’ve worked in different places at different times and I think I’ve learnt more and I’m better at the job I do for those experiences.”

The consultation also proposes much closer working with partners and explores the idea of using accreditation by other reputable organisations, such as the royal colleges, as part of its own assurance process.

Mr Behan said it was essential that the CQC was able to trust the judgements of partners such as Monitor and Ofsted - and vice versa - in order to reduce duplication.

The strategy also sets out plans to judge the culture of organisations by assessing how they handle feedback from patients and staff.

Mr Behan insisted this was not trying to anticipate Robert Francis QC’s recommendations in his report on the Mid Staffordshire Foundation Trust public inquiry and it would be “daft” to try and second guess him. The CQC’s consultation runs until 6 December and Mr Behan said any recommendation by Mr Francis which was relevant to the commission would be fed in to the strategy.

When asked whether he would be making changes to the executive team Mr Behan paused to consider his answer for almost 20 seconds before replying.

“I’m building a team that’s going to deliver this strategy and I want every manager and leader in CQC to support the delivery of this strategy. I don’t believe in charismatic heroes - I don’t believe in the cult of the leader. What I believe is that teams make a difference.

“The reason I hesitated [answering] is it’s not a straight yes and no [question]. Am I going to make changes? Of course I’m going to make changes but actually I haven’t come with a ready-made plan.

“I’m not King Canute. I’m not denying the tide is coming in. We have a really important job… The changes we’re going to make are far more important than these issues about who.”

Mr Behan told HSJ the CQC would not be afraid to speak up if it found the continued financial squeeze impacted on patient care warning the health and social care system not to be “naïve” about the situation.

He said: “As the financial challenges continue I think there is a real risk that quality could begin to be impacted… We have got a role, not just on quality for individuals and at individual service level but we need to comment on quality at the national level.”

Mr Behan said this was likely to take place through annual state of care reports into the various sectors CQC is responsible for.

He added: “We’re not a polemical organisation. We will be guided by what people tell us and if people tell us standards are deteriorating and we have got evidence for that through our inspection activity then it’s important we use that information.”

Readers' comments (9)

  • In many countries, those with management roles would be active in inspecting other institutions. This seems preferable to creating a large cohort of full-time inspectors.

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  • I quite agree. The processes of peer review and secondments into and out of the regulators are two elements which should help diffuse standards , aspirations and processes. We shall all watch with interest.

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  • This approach is very much to be welcome and marks a significant departure with the previous failed regime. The key issue for providers is that we respect the judgements of inspectors and, with some exceptions we don't, because they have neither the experience or expertise needed to do their jobs. We have had troops of inspectors who patently have little to no understanding of health care but pretend that they do; they march onto wards and announce themselves as 'we are the people that can shut you down'. So a new cohort of genuinely experienced people is required as well as a new start to inspection and regulation. No small task but I'm sure David knew that he was taking on a hugely dysfunctional outfit.

    I wish him the very best.

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  • what good looks like - does he have any idea what he is managing?! Any idea at all.
    How could you take over the CQC and not start with a statment that it is not fit for purpose but will be made so etc...?
    The CQC has become a laughing stock and one of the worst organisations out there, what kind of misguided stupidity is this?
    Was it not the Parlimentary steering committee that summed up their cross examination with "this has been a car crash" which led to his predessor falling on her sword. What good looks like...it is clear that Behan does not!

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  • Two days ago HSJ is quotes as saying:
    Care Quality Commission chair Jo Williams has announced she is to step down from the regulator.
    The announcement comes just days before Dame Jo is due to appear at health select committee where she was likely to face a grilling from MPs and questions about her position.

    What does Monsiour Behan think he is managing - the NHS can learn from the CQC LOL!!!

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  • In the days of the Healthcare Commission review teams were made up of serving managers and clinical professionals coordinated by a HCC staffer.

    It provided contextual understanding that I believe was valuableas part of those reviews.

    I know the framework has changed and is now regulatory rather than the HCC's supportive and developmental approach but the same need for understanding the context of life in the NHS still stands.

    As one of the clinical professionals on a number of such reviews I found it an excellent development opportunity that has helped me in subsequent roles I have undertaken.

    This all sounds eminently sensible to me.

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  • there is no doubt that peer review is the way forward All aspiring directors should spend a year or two benefitting from that experience Likewise inspectors should be seconded to organisations to see if they can implement recommendations !!

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  • So we all agree it's an excellent idea. And peer review is effective. But try getting a job at the CQC. The job descripton for assessors required none of my hard earned senior clinical and general management skills, but did need PACE interviewing- which can be learnt. The salary was middling Band 7- not likely to attract the most experienced.
    Please make these jobs secondments. We all have a vested interest in the CQC delivering, and the experience would be good for managers and senior clinicians- likewise the CQC would benefit from the fresh input, particularly in areas where there are recruitment difficulties.

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  • Anonymous | 12-Sep-2012 5:05 pm

    Agree.

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