Submission to CQC: Response to 'A New Start'
Patients, service users, their carers and families want care services which are safe, which do not breach standards and which are effectively monitored, inspected and regulated.
As Berwick’s recent report makes clear, service user involvement is indivisible from and indispensible to patient safety. Moreover, safety is not the only aspect of care services which is important to service users. There are longstanding demands for better coordinated, more personalised services which support service user involvement, empowerment and control.
The CQC in its initial conception was oriented to promote and encourage these, through the primary and secondary legislation that established it. Other key parts of the health and social care system are currently aligning towards these patient involvement and empowerment objectives, notably through the statutory duties and Mandate objective for the NHS commissioning system to promote the involvement of each patient; the national integration initiative; the vision and strategy of NHS England for meeting the long term conditions challenge; and the provisions of the Care and Support Bill.
In this response to the CQC consultation, ‘A New Start’, National Voices expresses a range of significant concerns that the current, necessary focus on implementing learning from the final report of the Francis inquiry risks marginalising service user involvement and empowerment at precisely the time that the rest of the system is beginning to catch up.
We have concerns that the preoccupation of this consultation document with basic safety in NHS acute hospitals, and the associated discussion of ‘fundamental standards’, put at risk the durability and comprehensiveness of the regulatory regime; and that the proposed approaches have a tendency to be paternalistic and regressive.
While we welcome and support some of the proposals – the hospital inspection approach, and the incorporation of the duty of candour into regulations, for example – we seek a basic reconsideration and reconceptualisation of approaches to ensure that CQC regulation is capable of:
- covering ‘quality’ comprehensively
- setting standards that are applicable across care settings, and
- aligning with the movement of the health and social care systems towards
- ‘integration’ and sustainability, based on person centred care that supports user empowerment