The recent changes at the CQC have signalled a strong change in attitudes. The focus now seems to be moving from encouragement to punishment.
This is an unwelcome change which is misguided if those advocating the changes believe that enforcement by punishment will drive improvements in quality. Experience shows that this move rarely works in practice.
If the CQC wishes to be seen as a guiding light for improving standards, it needs to introduce more balance into its underlying approach. The stick may be necessary but the carrot is also required and required to be very visible.
The CQC is a very powerful regulator and it should recognise this and exercise its power moderately and in a way which earns the respect that is so necessary.
The much publicised increase in prosecutions is a high profile example of this change in strategy. Prosecutions never drive up quality; indeed they may create a pervasive incentive to be defensive. Quality is improved by the recognition that lessons must be learned from mistakes. Fears of stigma are profound and financial penalty may well create the opposite of the desired effect. Financial penalties are wasteful. They simply serve to direct resources away from sure improvement into the Treasury’s coffers.
In addition the boasting of increase in prosecutions is not entirely accurate. Certainly the number of prosecutions has increased but from a very low rate. In the circumstances percentages are always misleading- the total number of prosecutions is well under a thousand in the last recorded year. When this is compared with the number of daily care episode interventions the number is truly insignificant. The real remedy for persistent, dangerous failure (and what should be covered for prosecution), is the taking of steps to remove a provider from business. I would argue that the nature of failure needs to be analysed to see if it justifies exclusion to trade. If not the policy should be directed not to the short term warm feeling of punishment but rather to encouraging cause analysis and experience sharing which encourages reflection without the fear of stigmatisation.
Providers and staff need to be encouraged and rewarded for some improvement which should be reflected in increased returns and employment terms.
The CQC should also reflect on improving its enforcement practice rather than relying on raw power to achieve its short term purpose of pandering to individual public concern. The public will not respect a regulator which fails to heed the wider and broader practice, preferring to heavily publicise criticism and obtain an immediate headline which neglects the care service generally.
Providers and their staff have a role to play in this. Services will be improved and staff skills will be honed by honest and reflective review of incidents. That learning is the best way to improve. It is absolutely not achieved by short term politics of fear.
Regulators, staff and providers need to work carefully together to achieve constant improvement which will drive up quality standards to the clear advantage of service users and those who work so hard to provide the services so vitally needed.
In that way good quality services can be sustained and will drive greater and wider investment. We urge the regulators to use and not abuse their powers in the intent of the common goal of service quality improvement.
