Who regulates the regulators?
12 July, 2013
All of the recent press about the Care Quality Commission has prompted me to think more broadly about inspection and regulation, and why we never seem to get it quite right.
Over the twenty or so years since I began my career at the Audit Commission (who remembers John Major’s Citizen’s Charter?), it seems we’ve reinvented our regulators literally dozens of times. And how many more dozens of times before that since the emergence of the first recognisable regulatory regime in the late 1960s, when Richard Crossman was secretary of state for health and social services (‘integration’ not such a new idea after all…) and discovered that there had been mass abuse of mental health patients at the Ely Hospital in south Wales (interesting stories of disappearing and redacted inquiry reports back then too, for any real history buffs among you)?
How many reorganisations of the system? How many debates about its effectiveness? And how many rebrandings?
We’ve got all of this wrong somehow. What should really matter is not the form of regulation, or the name or governance of the organisation that controls it. What should matter is service quality, safety and care: public service reform and meeting the massive efficiency targets - in health and local government - that we are facing.
So we need a regulatory system that identifies, incentivises, rewards and shares these things - that can support the management interventions that deliver genuine performance improvement and innovation.
There’s tons of information and data out there, in various forms and to various standards of quality - much of it gathered by various iterations of the regulators themselves over the years. And we all love to constantly reinvent and refine it. But the problem arises when NHS and local government services are confronted with the need to use this data, to understand it, and to make change. Our public sector has always struggled with this, and it has never properly been addressed by regulators or by the system - despite their constant restructures.
I think this is the real challenge for the new CQC. And for whatever emerges as a new regulatory system for local government. It’s action that matters, not review. And certainly not endless debate about blame and about structure.