Care Quality Commission chair Baroness Young has pledged to crack down on NHS organisations that fail to adopt National Institute for Health and Clinical Excellence guidance.

Ignoring guidelines could result in marked-down annual assessment ratings and lower pay, she told HSJ in her first interview in her role at the new health and social care regulator.

She said: “The system has been patchy in implementing NICE standards. So it’s about saying: ‘Well, you only get your good quality rating if you meet NICE standards.’ We need to up the ante.”

The tougher approach will reflect the emphasis on quality and expanding NICE’ s standard-setting role described by health minister Lord Darzi in his next stage review, she said. “We’re really pleased about the focus on quality. It’s just terrific and gives us some real opportunities because there are a number of things in the Darzi package that fit well with what we’re doing.”

The NHS constitution grants patients the right to receive any treatment deemed by NICE to be cost-effective.

Performance-related pay was another way to get NICE standards adopted, Baroness Young said. “I’m a great believer in performance pay. It’ll be interesting to see what happens about incentivising.”

Official launch

The CQC will absorb the Healthcare Commission, Commission for Social Care Inspection and Mental Health Act Commission, operating in shadow form from October before launching officially next April.

The Healthcare Commission already assesses the NHS’s compliance with NICE guidance through national audits, service reviews and the annual health check.

In last year’s annual ratings, the core standard on whether organisations comply with NICE technology appraisals was the seventh least complied-with part of the assessment.

There were 43 NHS organisations that did not meet, or did not supply sufficient assurance of meeting, the standard in 2006-07, although performance has improved in this year’s self-declarations.

The other core standard relating to NICE guidance was failed by 27 organisations last year, including a number of foundation trusts.

Haphazard compliance

Peter West, senior research associate at York Health Economics Consortium, said compliance could be “haphazard” among clinicians who resisted change, but finding evidence of non-compliance could be hard. “Hospitals have data systems that pre-exist NICE. We can find out a drug is being prescribed but not how much of it is being used by patients who, according to NICE, need it.”

Baroness Young’s comments co-incide with the launch of a draft CQC manifesto, rooting its principles in transparency, independence and risk-based inspection. Outcomes will be a major focus, and the CQC will judge its own success against them.

She sees her role as primarily serving patients and carers: “They’ll only trust us if we’re robust open, transparent, reliable, and evidence-based.” But she wants a good relationship with the NHS. Deregistration - a penalty outlined in the Health and Social Care Bill - would be rare.

The CQC’ s main benefit was its perspective across health and social care, she said, and chief executive Cynthia Bower’s social care expertise would balance her own experiences in the NHS.

Barbara Young on:

The CQC budget

“It is£160m but obviously that was set some time ago and since then the government has invented a whole load of things for us to do.”


“I have never been egged on by quite so many ministers to be independent. I have been a regulator in a number of different departments and I have never had it thrust upon me as eagerly as I have at the Department of Health.”


“Not being able to register is a myth. We are not going to march on Guy’s and St Thomas’s and say ‘we’re not going to register you’. There may be occasions where the odd service may be a bit naff but either on a temporary or permanent basis we will reach agreement locally.”


“Darzi will help with that. It is really important. If Darzi pushes that at a very fast rate that will be terrific.”

Q&A - registration

HSJ asked Baroness Young what the NHS can expect from the new registration regime

HSJ: How many trusts do you think will struggle to register with the Care Quality Commission by 2011?

Baroness Young: Not being able to register is a myth. The importance of the registration system is it is the beginning of the relationship… There will be some institutions to whom we say “we’re going to register you but there are areas where you need to make improvements”. They will be given an action plan. Withdrawal of registration will be a fairly rare event for big providers unless there is lots of spare capacity.

What are your thoughts on the planned registration requirements that have been consulted on?

We have just received the results of the consultation. We want to make sure it is modern, risk based, proportionate regulation. Becoming registered is only the start of the relationship. It will look very different for big acute trusts compared with very small care homes.

Should primary care be included?

We are keen to bring primary care into the registration system - the public are interested in the quality of general practice. One of our principal roles is to have information that the public understand and that is appropriate to making choices.

How will accreditation schemes, such as the one being drawn up by the Royal College of GPs, fit in?

Right across the way that we regulate we will have to look at other quality assurance systems and decide whether they are robust enough, ensure the right range of things and that they are properly validated. If they are, we will want to use other people’s systems - we want to work with colleges right across the board.

See this week’s leader for more analysis.