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CQC moves to assess trust leadership in response to Francis

The Care Quality Commission is to assess the leadership, culture and governance of acute services in the NHS and the corporate governance of private sector care providers, HSJ has learned.

In an email sent to staff last week, chief executive David Behan and chair David Prior set out their “early thinking” ahead of the publication of the Francis report.

The long awaited report into the failure of the system to spot problems at Mid Staffordshire Foundation Trust was due to be published on 6 February.

Chair Robert Francis QC was widely expected to make recommendations on the operation of the quality regulator.

In the email, Mr Behan and Mr Prior commit to using more professional experts in inspections and more patients as “experts by experience”. The regulator is already in the process of setting up a bank of 200 health and social care professionals to support its inspectors and it has recruited 136 so far.

Both the use of more professionals and an increased focus on the culture of organisations regulated by the CQC were expected to be key recommendations of the Francis report.

A recent report from the Commons health committee also recommended CQC inspectors increased their focus on the culture of organisations.

Currently the 16 essential standards which the regulator inspects against relate mainly to service delivery on the frontline.

The email to CQC staff states: “Our regulatory approach will change to ensure we assess the leadership, culture and governance of acute services in the NHS and the corporate governance of large providers of adult social care services.

“We will want to assure ourselves that there is an environment where professional standards are high and a corporate culture that is people-centred, open and encourages people to speak out.”

The email says it is too early to set out changes in detail as the board will need to consider the recommendations from Mr Francis and the responses to the recent three-month consultation on the regulator’s future strategy.

It also responds to ongoing criticism, most recently from the health committee, that the regulator was not clear about its purpose. The latest criticism was viewed as unfair by many people at the CQC.

The email states: “Let us be clear. The primary responsibility for delivering quality care lies with care professionals, clinical staff, providers and commissioners. You cannot inspect and regulate quality into care. Our purpose is to ensure that those we regulate provide services that are both safe and to an acceptable standard of care quality. We expect those standards to continuously improve.”

Readers' comments (19)

  • CQC needs to put own house in order At the moment it has very little credibilty in the serviceand the question is what future does it have after the Francis Report

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  • Actually I welcome this. Leadership and culture are paramount to safety and quality. However, as a leadership specialist, I would urge CQC to ensure they are utilising assessors who really understand leadership & behaviour in depth. If you don't you judge from your own bias.

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  • "The latest criticism was viewed as unfair by many at the CQC."

    Could you link to an article where this rebuttal is made more substantively?

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  • Pot & kettle come to mind!
    Wasn’t one of the condemnations reported by a CQC board member to the Stafford enquiry related to problems with their (CQC) own Leadership & Culture?
    A compliant of a bullying culture was denied (of course it would be, they would hardly admit to it but there is still plenty of anecdotal evidence that things haven’t changed that much
    It is hard to believe that two new recent appointments (one just over 6 months & one for 2 days) have made that many changes

    Perhaps they should show that things have changed internally before unleashing what will undoubtably be criticism elsewhere

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  • Mmmm, CQC to monitor Culture! By who's standards?

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  • I work for CQC. Top level may aspire to this, but nothing on HOW they're going to achieve it. Doesn't feel any different working for them now than it did last few years. Too many poor decision makers/managers in CQC.

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  • Arguably poor judgements about the quality of leadership are worse than none at all. It was one of the areas the HCC Investigations Team covered but it's not easy and is very time consuming to do properly as involves cross checking what people say against the reality as evidenced by board minutes, strategic documents, governance papers etc across a period of time. I doubt if the CQC have the time, expertise and resources to do it justice. And again, done poorly will give false assurance or unjust criticism. Have lttle confidence this is safe in CQC's hands.

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  • Just to be clear - the primary responsibility for safety and quality is the provider of healthcare. CQC reviews for failures of care.

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  • Peer review of this area would be better . Lets have recognised leaders participating in reviews My view is that all chief executives should undertake at least one visit bi annually The learning will be two way

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  • I t is of concern when existing CQC staff remain concerned aboutmanagement style and capabilitywithin the organisation and former staff question its ability to undertake these reviews

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  • Anon 7.31 that is what the Commission for Health Improvement (CHI) did. To be fair it was a fairly intensive process but it took a range of senior and exec staff from the NHS and used them to undertake peer reviews. The additional benefit was that those peer reviewers often went back to their organisations with a completely different view of what good looked like. People who were part of a CHI review often considered it to be a really developmental approach. It was a truly outstanding organisation to be part of and I consider it to have been a privilege to have worked there.

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  • To be in senior management the requisites are
    Bully
    Poor judgement
    Bad decision making skills
    Blame every one else for mistakes
    Don't listen
    No transparency
    No financial acumen
    No sense of responsibility or ownership
    In return recieve a 6 figure salary

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  • The CQC in the future in terms of assessing organisations also need to take account of the external as well as the internal factors also driving the agenda of the organisation's leadership for example the impact of commissioning intentions and contracting and such things as demand managemen leading to organisations having to implement significant savings programmes whilst seeking to maintain and improve the quality of services.

    Peer review when conducted well - works well - and can really help to influence change and drive improvements and importantly gets the buy in of the clinical and management teams.

    Finally, the post commented above about the quality of senior leaders is rather depresssing - however, if people behave in that way - it is important to understand what is driving that behaviour -and tackle it.

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  • Jan Norman I entirely agree

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  • The letter states: “Let us be clear. The primary responsibility for delivering quality care lies with care professionals, clinical staff, providers and commissioners. You cannot inspect and regulate quality into care.

    But it is the job of the inspection regime to respond to complaints and take speedy, decisive action to deal with failure for whatever reason.

    This is the second time this week we have heard this 'defence'. That's worrying.

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  • I am really delighted to see CQC is going to focus on leadership. The organisational culture and leadership are the key to the success or failure of the organisation and leaders are the key. CQC must find a way of identifying leadership not simply at the Board but also throughout the organisation including each Division and department. It is only when we have excellent culture, leadership and energy at every level or the Trust and good working relation between Primary, Secondary, Community and Social services that we can provide excellent quality care to our patients.

    Every newly appointed senior staff should have leadership training as a part of their induction and introduction to the organisation. This should include all newly appointed consultants, specialty doctors, senior nurse and managers. This training must be multi-professional and should include topics like patient safety, quality, effective team working, challenging colleagues and doing so constructively, escalation policy of the Trust, effective whistle blowing but doing so professionally, value, quality, patient experience, customer care, effective communication and patient and public feedback.

    Hopefully Francis report will be used to make our NHS better rather than looking for scapegoats and introducing more regulation and more bureaucracy, more inspection and more of the same hotchpotch regulation.

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  • It obviously makes sense for leadership and organisational culture to be assessed as part of any holistic view of an organisations capability. However Monitor also have this in their mission so there is a real danger of different standards, approaches and assessments. Unacceptable; needs sorting.
    More pertinently CQC would have to be capable of delivering such judgements on an industrial scale; across Trusts in different sectors, primary and social care. As presently established they are not remotely competent to undertake such judgements. As a leader with 25 years board level NHS experience I have been saddened at the poor level of competence at even the most basic inspection within CQC. Some very good people, of course but too many fall into the `those who can't, inspect' category of ability.

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  • This about standards, values and ethics.there are some brilliant managers in the NHS and unfortunately some rogues. Let's stand by our belief and personal standards and get rid of the rogue managers

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  • This about standards, values and ethics.there are some brilliant managers in the NHS and unfortunately some rogues. Let's stand by our belief and personal standards and get rid of the rogue managers

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