Introduction to the Care Quality Commission’s Regulation of Health and Social Care Providers

Since April 2010 the Care Quality Commission has gradually introduced legal requirements for a number of organisations, in relation to the provision of health, adult social care and dental services. These requirements relate to all providers of a regulated service as defined by the Health and Social Care Act 2008.

The Care Quality Commission has developed a document detailing the Essential Standards of Quality and Safety that they have identified providers should be meeting in order to be delivering services in a safe and patient focused way. These essential standards replace the previous guidance provided in the form of The Standards for Better Health for NHS Trusts and the previous regulations under the Care Standards Act 2000.

Under the CQC’s new system, the intention is that all registered providers will be demonstrating the same set of essential standards of quality and safety whilst also demonstrating respect for their service users’ dignity and rights. This uniform set of standards applies across the board, whether providing community based healthcare, domiciliary care within the home or long term residential nursing care. The focus of this new registration system is the assessment of outcomes from the point of view of the patient or service user.

This means that providers will need to be able to demonstrate that their patients are happy with the services that they are receiving and that they have proactively consulted with them in designing and re-designing their provision. This patient focused approach thus demonstrates a slightly different approach to the previous regulatory body, who were more targeted towards the implementation of robust policies and procedures. Further differences can be seen in the fact that providers will need to be registered for each regulated activity that they carry out rather than as an organisation as a whole; the regulated activities that require registration are listed below:

– Personal Care
– Accommodation for people who require nursing or personal care
– Accommodation for people who require treatment for substance misuse
– Accommodation and nursing or personal care in the further education sector
– Treatment of disease, disorder or injury
– Assessment of medical treatment for people detained under the Mental Health Act 1983
– Surgical procedures
– Diagnostic and screening procedures
– Management of supply of blood and blood derived products
– Transport services, triage and medical advice provided remotely
– Maternity and midwifery services
– Termination of pregnancies
– Services in slimming clinics
– Nursing care
– Family planning services

With such a broad spectrum of activities that need to be registered it is hoped that this new system of registration will ensure that services are being provided in line with service users’ needs and that patients can expect a uniform approach to the care and treatment that they receive regardless of when or where it is delivered. Additionally, with details of registrations being made available on the Care Quality Commission’s website it will be possible for the general public to assess a service’s registration status and compare it with alternative options, thus providing choice and an incentive for providers to maintain and/ or improve standards.

The Powers of Professionalism in Partnerships: Health and Social Care?

The NHS and Social care reforms is a forum to intensify competition as well as collaboration within the sectors. Competition is not a new phrase rather; it should be welcomed with open hearts. We can draw our reference from the NHS and Community Care Act (1990), which introduced “Internal Market and GP Fundholding”. Despite all the changes that had occurred in the organisations, competition has not been destabilised but remains every day practice in different forms and shapes. On reflection, delivery of services would synchronise with policies on resource availabilities and this would continue to do so in the present economic climate. By contrast, the powers of professionalism in partnerships; in a modernised sector would recreate opportunities to reformulate strategies capable enough to manage competition in the organisations.

Competition within the organisation should not be interpreted as a “fight between one department and another” rather is a market opportunity that promotes negotiations along specialist services delivery. In conforming to the new approaches of delivering health and social care, the GPs, whether alone or in partnership with local authorities and others will compete for; hospitals services/treatments, mental health services, community clinics and other willing contracts. In practice, the health bill will help to seal the endeavours, giving assurance and legality to quality services delivery and maximisation of resources. Nonetheless, competition has been in practice in the private sectors for a long time and has maximised quality of services delivery and flexibility in the wider consumer markets.

By contrast, why should the professionals and related support staff within the organisations are ambivalent about competition and partnership working, which has become the buzz words of recent years? Professional opinion suggests that integrated care produces; economy of scale, efficiency and effective utilisation of skills mix, maximisation of resources and a reduction of services’ duplications between agencies. This is an indication for savings in the sectors. Critics could argue that competition means a casualty of the health and social care; as patients become commodities that is passed or snatched from one profit centre to another. This could be correct however, in any business whether it is a welfare service or profit-making organisation, the key objectives are to minimise waste, delegate responsibilities to specialists and establish a cost centre that is capable enough to monitor spending in line with budgets.

In the current economic climate, competition could be seen as the antithesis of collaboration between agencies, ensuring maximisation of financial resources and labour capital facilities. Conversely, in the private sector, cooperation is strengthened by government legislation, regulations and the courts intervenes if they think companies are ‘collaborating’ over price fixing or practicing monopoly. We can draw our references from the superstores who are regulated and monitored by the “Trading Standards”.This means they can not fix prices or over charge the consumers. In practice, none of the superstores would monopolise the entire grocery market. In parallel to health and social care organisations, there is no formula by which the public sector can have its cake and eat it. There is a number of legislation and policies restraining monopoly in the sectors therefore, the agencies can enjoy the cost-cutting pressures of competition without atomising services, and neglecting the interests of the public.

In retrospect, the opportunities within the agencies are its professionalism. Doctors, social workers, occupational therapists and nurses will say their training and ethical commitment means putting the interests of the patient and service users first. However, other interests matter, including their own pay, health and safety as well as maintaining their own standard of living. Another way of putting it is to say clinicians internalise the conflicts that inevitably arise and we are happy to let them get on with the reconciliation. In recent times, services and care are prioritised within eligibility matrix, but professionals are able to put side by side to their principles and their practice.

The fundholders (GP, Social Workers, and Commissioners) could compete, but their shared professional identity prevents competition leading to anarchy. Both the NHS and social services relies on staffs that are not professionalised such as the managers and support services staff including the commercial departments, facilities management teams and financial services to manage their budgets. In hindsight, as long as the GP, the chief executive of the local government, the physiotherapist and the receptionist in the sectors think they are part of the organisations and have the common interest then, competition can be accommodated.

Professionalism and organisational behaviours are restraints of reckless trade, according to the legislation and policies governing the welfare institutions. However, in restraining economic principles and markets within modernised services would not offer protection to service users and patients, who otherwise would be treated as consumers that have no opportunities to make choices in the market. In practice, the GPs, hospital consultants and social services works as partners in care, and this is because of their professionalism and a common sense of belonging to the wider welfare service. To support the agreements and legality, drawing up a contract seems to be the only way, which by its very nature is going to supervise and regulate health and social care delivery. This is to ensure service users and patients who might be at risk by the nature of their ailment are not exploited.

Partnership has become a popular word to use within the public service especially when the spending taps are gushing. In health and social care, in particular for children services, the previous government spent time and energy in trying to align the interests of councils, the NHS and other service providers. By contrast, the coalition government should give details of what is working well, and support good policies that were implemented by the previous New Labour administration