Three divides

There’s plenty of talk of integration when it comes to services, but what about the national bodies which regulate and support those services? Here are three divides which don’t make sense to me: what could we do to integrate across them?

1. The divide between inspecting the quality of services and helping those services to improve. CQC inspects the quality of services but has no remit to support services to improve, for which a struggling service would need to approach one of a range of agencies which are largely non-statutory and less securely funded, such as the Social Care Institute for Excellence (SCIE) and Think Local, Act Personal. Shouldn’t we do both at once? Failing NHS trusts and GP practices can access some funded improvement support, but social care services cannot.
2. The divide between inspecting quality and ‘economic regulation’. CQC inspects the NHS and social care services for quality. Monitor is the economic regulator for the NHS. There is no equivalent to Monitor in social care, other than a limited CQC duty which affects a few of the largest social care providers if they get into serious financial difficulties. It’s not possible nor sensible to look at quality and financial viability in isolation from each other. NHS Trusts which are driven only by balancing the books will make all the wrong decisions when it comes to achieving outcomes and real value for money, which can only be done by taking a holistic view of the local health and care system.
3. Regulating providers but not regulating commissioners. Both used to be inspected, but now it’s only providers. The problem with this is that some of the issues which inspectors find with providers are actually problems with what commissioners decide to buy and how much they are willing to pay for it. There have been many abuse scandals, but have any commissioners been held to account for years of squandering public money buying no-outcome, dangerous care, rather than using that money to develop services which help people to live well? When services are found to be failing, commissioners have as much of a role in fixing the local system as providers.

At the moment it’s possible for large amounts of money to be spent on separate inspections of the quality and of the finances of the same NHS trust. Further separate inspections could find social care services failing. None of those inspections can contribute to fixing the problems they find and they will not even consider the role commissioning of health and social care is playing in creating pressures and gaps, nor will they have much to say about the way in which failings in one part of the system are creating problems in another.

We need a more holistic picture than that.

There may be a case for merging some of these bodies. In the meantime, there is certainly a case for them working as closely together as the law allows.