Boards need to move from “putting all their investment into quality and safety” to achieving a better “balance” with financial success, the chief executive of the Care Quality Commission has said.

  • New approach to apply to trusts and foundation trusts from next April
  • Measure would not require substantial additional CQC staff
  • CQC will “do it right” rather than “do it quickly”

David Behan was speaking to HSJ about the health secretary’s plan for the CQC to consider “use of resources” in its rating of NHS trusts and foundation trusts. Jeremy Hunt revealed the move in an interview with HSJ yesterday afternoon.

Mr Behan said he supported the change as a “logical development” of its current approach.

Asked whether the announcement, along with other national moves to accelerate NHS cost savings, would reduce the focus on care quality, he said: “It’s now time, as we move over this next five year period, [to] get these in a balance.

“Rather than [moving to] a position where money trumps quality, this is saying successful organisations need to get a balance between quality and finance.”

He said the NHS had reacted to the “shock” of the Mid Staffordshire care scandal and the Francis inquiry by prioritising quality and safety, adding: “I’ve heard chief executives say, ‘I’d rather break the budget than fail a CQC inspection’.

“That seems to me to suggest what people are doing is putting all their investment into quality and safety, which is a good thing, but at the cost of the budget, which isn’t a good thing.

“What we’re now saying is we need to get a balance between keeping a focus at board level on quality and safety and keeping a focus on the money. It’s a big challenge for a board.”

The new approach was intended to apply to all trusts and foundation trusts, but not to GP practices, from April next year. Mr Behan indicated it would be extended to GPs in future.

The CQC, with other regulators, will consult on detail of the approach in coming months.

Mr Behan said the introduction of consideration of “use of resources” would not require substantial additional staff for the CQC and could draw extensively on data analysis. However he said the organisation, which has previously delayed its existing inspection timetable due to lack of capacity, would “need to consider very carefully” the impact on its work.

He said the CQC board had discussed whether taking on the responsibility would mean “diluting our focus”, and had concluded that it should take it on. However, he said its approach would be to “do it right” rather than to “do it quickly”.

He continued: “Our strategic challenge over the next five years is how we can continue to regulate quality and safety during a period of continued austerity.

“One of the key issues is about the sustainability of services - it’s not just are they safe and high quality now. It’s entirely logical that… we need to take a perspective on how well resources are being used, because that’s absolutely critical to the sustainability of those services in the future.”