Andrew Lansley has told HSJ the Care Quality Commission is now running a “proactive and tough” inspection regime and revealed he does not favour further reorganisation of NHS regulation.
In an exclusive interview, the health secretary also said he favoured the creation of “accountable care organisations” to drive integration, was close to giving “reassurance” on education and training policy and reiterated his support for small clinical commissioning groups.
He said: “People would recognise over the course of this year [that they] have been doing exactly that. Across the NHS there’s an appreciation the CQC is now not just arriving in order to tick boxes on whether you’ve got policies in place.”
He said the Department of Health review of the regulator, reported previously in HSJ, was the first instance of a process which would also be carried out for other health bodies. It was “not about” ministers’ confidence in the current CQC leadership.
The Mid Staffordshire Foundation Trust public inquiry, whose terms of reference include the regulatory system, will report next year.
But Mr Lansley said: “In addition [to previously asking it to carry out more inspections], I have no plans for changes to the CQC.”
He said that at Mid Staffordshire, “lots of people had formal responsibilities but nobody seemed to have delivered on them”.
“We will see what [inquiry chair] Robert Francis has to say but I don’t think it’s about whether there are people who have a responsibility for ensuring high standards, it’s actually about making sure the culture in the NHS achieves that.”
In relation to his current reforms, Mr Lansley said he thought the DH needed to encourage integrated services – something highlighted by the NHS Future Forum after the Health Bill was put on hold in the spring.
He said: “Commissioners clearly can support it [and] we can support it through things like tariffs based on care pathways and bundles.”
Mr Lansley said there were also “things we can do organisationally”. He advocated the model of accountable care organisations, most commonly, although not exclusively, associated with the US healthcare sector. These are networks of providers which are given a pooled budget for patients’ care and are monitored on their performance and quality.
Mr Lansley said accountable care organisations could be beneficial “in so far as they bring hospital and community services together, in order to create an organisational form that is more integrated”.
But he added: “They have to do it in a way that doesn’t create monopolistic services that don’t offer patients choice.”
He said he planned to “give further reassurance” about education and training policy, in response to the current Future Forum review. This could involve further changes to the Health Bill.
Responding for the first time to the Information Commissioner’s judgement that the DH should publish its “register” setting out the risks of the reforms, he said the DH had yet to decide whether to appeal the decision.
But he said: “There’s a great danger if it’s published… it will tend to mislead. It will give an impression… there was an expectation [that all the risks would be realised]. The purpose [of the document] is to get open, honest internal reporting so all necessary mitigating actions can be taken.”
Speaking about the award of a management franchise to run Hinchingbrooke Health Care Trust to the independent provider Circle, Mr Lansley did not rule out a similar approach elsewhere in the future.
He said: “It wasn’t a quick process so to that extent clearly we wouldn’t replicate it in that form. I don’t at the moment have any plans for that specific approach elsewhere… That doesn’t mean we exclude it.”
* CQC chief executive Cynthia Bower told HSJ the DH had approved its recruitment of a further 230 inspectors for 2012-13 – an increase of nearly a third on present numbers. She also said the CQC was increasing the number of unannounced inspections each month.
Lansley: Smaller CCGs will be affordable
The health secretary said the administrative allowance for clinical commissioning groups would be large enough for small groups to operate.
Mr Lansley would not confirm the size of the allowance which is expected to be published in coming weeks. However, he sought to calm some CCGs’ fears that it will be too low to allow CCGs with fewer than 200,000 patients to be authorised. Some fear it will be as little as £20 per head.
He said: “The NHS is obsessed with size and organisational uniformity. In truth leadership matters more.”
Talking about competition rules, Mr Lansley said the current requirement for primary care trusts to carry out any qualified procurements by next year was in place because “if we don’t it won’t happen because that’s the nature of the system we’re in at the moment”. But he said: “In the future CCGs… will not have a formal requirement to undertake specific elements of choice.”
Mr Lansley said PCTs had already delegated £28.9bn to emerging CCGs, from a total of £62.3bn eligible to be taken on.