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Behan explains new care approach

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Dave Behan, the new chief executive of care regulator the Care Quality Commission, has explained his decision to reverse his predecessor’s approach to inspecting care providers.

Mr Behan gave his first interview since taking up the post at the beginning of July to LGC’s sister title Health Service Journal following the launch of a consultation on the regulator’s strategy for 2013 to 2016 and the day before CQC chair Jo Williams announced her resignation.

The strategy proposes a move back towards the sort of a more risk-based approach abandoned by Dame Jo and former chief executive Cynthia Bower a year ago when they committed to inspecting most NHS providers and care homes at least once a year. The move followed high profile public criticism of the CQC’s performance by the health select committee.

The new strategy proposes adopting a “differentiated” approach to regulating the three sectors CQC is responsible for – health, social care and mental health. It acknowledges the current commitment to annual inspection is unlikely to be sustainable.

Asked whether Ms Bower should have stuck to the original model, Mr Behan said her approach had been right at the time.

“What Cynthia did was develop CQC and get it started. She had the job of registering all services and that’s a contribution that Cynthia made.

“What this strategy is signalling and I am signalling is we’re now moving into a different phase.”

Mr Behan, who started his career as a social worker and was previously the Department of Health’s director general of social care, said it was important to be “unambiguously clear” that the CQC would still inspect all providers and carry out unannounced inspections.

However, he said the CQC’s emphasis was now on developing a model of regulation that made greater use of evidence, particularly information from patients and service users.

Mr Behan said more information was needed on how effective the CQC’s interventions were at bringing about service improvement. He revealed the regulator was commissioning an academic evaluation of its actions.

The CQC has been criticised by many, including the NHS Confederation, for a lack of consistency in its inspectors’ judgements. Mr Behan said questions over the expertise required by inspectors and how many inspectors were needed still to be answered. However, he suggested the CQC’s make-up could change dramatically.

“My vision for CQC is of an inspectorate where any successful manager in the health and social care sectors will see working at CQC for a period of time during their careers as an essential part of their career,” he said.

“If I look at my own career I’ve worked in different places at different times and I think I’ve learnt more and I’m better at the job I do for those experiences.”

The consultation also proposes much closer working with partners and explores the idea of using accreditation by other reputable organisations, such as the royal colleges, as part of its own assurance process.

Mr Behan said it was essential that the CQC was able to trust the judgements of partners such as Monitor and Ofsted - and vice versa - in order to reduce duplication.

The strategy also sets out plans to judge the culture of organisations by assessing how they handle feedback from patients and staff.

Mr Behan insisted this was not trying to anticipate Robert Francis QC’s recommendations in his report on the Mid Staffordshire Foundation Trust public inquiry and it would be “daft” to try and second guess him. The CQC’s consultation runs until 6 December and Mr Behan said any recommendation by Mr Francis which was relevant to the commission would be fed in to the strategy.

When asked whether he would be making changes to the executive team Mr Behan paused to consider his answer for almost 20 seconds before replying.

“I’m building a team that’s going to deliver this strategy and I want every manager and leader in CQC to support the delivery of this strategy. I don’t believe in charismatic heroes - I don’t believe in the cult of the leader. What I believe is that teams make a difference.

“The reason I hesitated [answering] is it’s not a straight yes and no [question]. Am I going to make changes? Of course I’m going to make changes but actually I haven’t come with a ready-made plan.

“I’m not King Canute. I’m not denying the tide is coming in. We have a really important job… The changes we’re going to make are far more important than these issues about who.”

Mr Behan told HSJ the CQC would not be afraid to speak up if it found the continued financial squeeze impacted on patient care warning the health and social care system not to be “naïve” about the situation.

He said: “As the financial challenges continue I think there is a real risk that quality could begin to be impacted… We have got a role, not just on quality for individuals and at individual service level but we need to comment on quality at the national level.”

Mr Behan said this was likely to take place through annual state of care reports into the various sectors CQC is responsible for.

He added: “We’re not a polemical organisation. We will be guided by what people tell us and if people tell us standards are deteriorating and we have got evidence for that through our inspection activity then it’s important we use that information.”

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