Everything you need to stay up to date on patient safety and workforce, plus our take on the most important under the radar stories. This week’s briefing is by bureau chief David Williams and senior correspondent Shaun Lintern.
The Care Quality Commission is not part of the NHS. Its job is to monitor and inspect health and care services from the outside, and to require action if they are not good enough.
But it does not exist to help the NHS improve. That is NHS Improvement’s job. Although the CQC will hold up examples of good practice to show where positive steps can be taken, its main role is to act as a mirror. The NHS must do the heavy lifting.
This separation of roles is designed to prevent the regulator becoming too close to the regulated.
An unwillingness among regulators to probe difficult situations has featured in almost every major health scandal of recent times. A certain distance is needed for scrutiny to be effective.
With all that in mind, consider the case of Birmingham Women’s and Children’s Foundation Trust. The trust has made an impressive signing in the shape of James Mullins, the CQC’s regional head of mental health inspections, who has been appointed on a six month secondment to turn around a service he had just rated inadequate.
The trust’s community child and adolescent mental health service was heavily criticised by the CQC last month owing mainly to organisational failings and staff shortages.
There is a limited pool of people with the right skills and knowledge to lead the CQC’s inspection programmes. Mr Mullins had worked for many years in providers before joining the CQC, and it’s not surprising he’s crossed back over. In order to be able to recruit the right people, the regulator needs to have a semi permeable membrane with the provider sector and a certain amount of osmosis is inevitable.
But this is the first example we’ve seen of a senior inspector joining a trust to turn around a service before its inadequate rating has even been reported – Mr Mullins joined the otherwise outstanding rated trust in December. That was five months after the inspection took place but two months before the report came out.
There will probably be a reinspection before the end of the year. The expectation is that Mr Mullins will be back at the CQC by then.
Question: is that not a glaring conflict of interest for Mr Mullins?
Answer: of course it is, which is why the CQC has assured us he will be nowhere near the inspection. Their policy on conflicts of interest wouldn’t allow it for at least five years.
According to the CQC, such conflicts are usually managed by bringing in someone from another regional team to undertake the functions performed by the head of inspection.
But even if Mr Mullins doesn’t run the inspection, there is the possibility that other mental health specialists will be involved who report directly or indirectly to him.
The CQC’s answer to this: “Mr Mullins will have no immediate future involvement in any regulatory activity concerning Birmingham Women’s and Children’s FT. To carry out their role our staff must demonstrate high standards of professional conduct and impartiality at all times.”
Is that enough to ensure no one’s judgement is clouded by having to mark their boss’ homework?
The CQC says it has not yet decided whether the CAMHS will be reinspected in isolation or form part of a whole trust inspection.
The latter is preferable because it would be owned by the chief inspector of hospitals.
The wider context to all this is that the CQC is moving towards having a named inspector for each provider. The thinking is this will improve knowledge of the sector they’re regulating and build relationships with providers. This is sensible in as far as a good regulator must have strong knowledge of local context and issues. And good relationships are nice to have.
But what of the essential separation between the CQC and the NHS?
Building up the role of inspectors who are also responsible for developing relationships carries some major pitfalls.
The most obvious is that better relationships between the CQC and provider sector could make the inspectorate worse – not better – at independently judging whether a service is risky or unsafe.