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New regulation of care systems could help create parity between councils and NHS

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LGC’s essential daily briefing

Sir David Behan’s call for legislative change to give the Care Quality Commission new powers to rate local systems would mark a significant regulatory shift away from the traditional focus on individual organisations, to a welcome acknowledgement that health and social care services are a complex web of interdependence.

The departing CQC chief executive said the 20 local system reviews had brought the “oxygen of transparency” to areas, breathing new life into relationships between leaders and organisations which had broken down, or had never been established in the first place.

Sir David said these changes in behaviour would not have occurred without the reviews. He argued the reviews should be extended to become “part of the routine way we do our business” and enable the regulator to assess how the system’s component parts intersect and interact.

While significant progress has been made to reduce delayed transfers of care (DTOC) nationally, trends since the introduction of government targets last year reveal some areas continue to struggle. These could likely benefit from the reset a system review could provide.

While any further extension of regulation may be met with some suspicion and reservation, a new approach could aid councils caught in systems which remain fraught and fragmented.

In October last year, as some councils were being placed on the naughty step by the government for their DTOC performance and local system reviews were getting underway, the CQC’s chief inspector of social care Andrea Sutcliffe said a “heightened level of tension” between the NHS and some councils had the potential to fracture the relationships that are so fundamental to improvement.

She also echoed the concerns of many in local government when she told LGC a focus on short-term targets would not necessarily benefit elderly people.

Ms Sutcliffe implored councils to not consider themselves to be like “a little brother or sister” to the NHS. She said a more assertive approach by councils would challenge a lack of “appreciation” in the NHS of democratic accountability.

Fully integrated services that break down organisational and psychological barriers to reduce complexity, inefficiency and risk to patients must remain the goal, particularly as demand and financial pressures continue to rise.

At its best, a balanced and bold new approach to regulation could have an equalising effect, with all organisations judged not only what services they provide or commission but also how they enable partners and the wider system to function.

With politics at play, there is always a danger that the centre’s focus on the NHS could disrupt and distort attempts to establish a proportional and balanced new inspection regime.

Some would argue the role of NHS England and other national NHS bodies in local systems should be considered under a new system. As one commenter on LGCplus asked: “Are they a supportive or bureaucratic/destabilising influence?”

However, potential pitfalls aside, new regulation could not only be an opportunity to focus minds across the system, but also give councils parity as equal contributors to a common goal and ensure they are fully respected and valued as a key driver for improving people’s lives.

Jon Bunn, senior reporter

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