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Sunday, 23 June 2013

Regulation and Assurance: Doing the Right Thing

This week the controversy surrounding the CQC will have caused many of us working in regulated areas and sitting on Boards to think deeply about our roles and our behaviour.

We cannot and should not expect Boards or regulators to take the place of management and know what is going on at a detailed operational level on a day to day basis. Indeed, executive managers are skilled at making sure that Boards do not get involved in day to day management, and regulators are by their nature in less than regular contact. 

What this means is that our expectation should be that executive managers will run their organisations well, understanding how to maintain safe, good quality and consistent practice and to assure themselves that this is happening. Boards and regulators will then 'dip in' to test this on a regular or occaisional basis.

When things go wrong, Boards and regulators can support and oversee improvement plans, and retest practice and outcomes to assure progress. This process relies on the truth being told in terms of information and analysis produced and what people say in face to face interviews.

Triangulation of patient, customer, public and stakeholder views is important in challenging data and narrative about what is going on - at Winterbourne View, Mid Staffs and Morecambe Bay, people said things were wrong, but they were ignored and suppressed until it was too late, and irreparable damage was done.

It has been shocking to hear the suggestion this week that the regulator itself had been willing to engage in cover ups - if they are afraid of the truth, who can the public trust?

Public services - and particularly those which are literally about our lives and deaths - are based on trust, and if this breaks, catastrophe can appear in the cracks.

At every level of our public services, and especially those which care for us at our most vulnerable, we must have people who recognise the importance of safety, quality and consistency and who are prepared to challenge within their own organisations to ensure the highest standards and the effective management of risk. They must also be prepared to recognise when things have gone wrong and to put them right - to fear the consequences of poor practice rather than the embarrassment of bad PR.

We should know what it is to do the right thing, and if we don't we should work it out together. 

The CQC has been forced to take a long hard look at itself - public confidence is very low. But they should not be alone in this. Regulated services cannot rely on their regulators to tell them when they are going wrong - it may already be too late. The primary focus and responsibility for safety, quality and consistency must be held by those who directly serve the public. 

Other players are also in the frame - the government, civil service, legislature, commissioners. They must recognise and be open to pushback about the impact of their demands on services. The push for earned autonomy through mechanisms like Foundation status can clearly distort the views of hospital trusts trying to respond to pressure from the Department of Health/NHS and Monitor But it is literally fatal to ignore or even hide service failures in the interest of passing the 'exam'.

Whilst we understand the drive from commissioners to try to get more for their money as demand for health and social care outstrips the resources we can make available in our society, this has to be done in safe ways which assure quality. There is a proper concern about the impact of downward cost pressure on pay and staff quality which seemed apparent in Winterbourne View.

These examples of failure are dreadful, but they are not universal, thankfully. What this suggests to me is that the system, if it is distorted and not properly managed, can fail us, but crucially we need to rely on people to do the right thing. In a system where poor and excellent practice can sit side by side, it is the intentions, commitment and energy of good people making the right choices day in day out underpin our best public services.

Find our more about our work with regulated public services and Boards at The Open Channel