Memorandum submitted by the Picker Institute (H&SC 7)
Health and Social Care Bill 2007
Picker Institute statement to the Public Bill Committee
1. The Picker Institute welcomes publication of the Health and Social Care Bill 2007 and supports the integration of health and social care regulation and quality assurance.
2. The Picker Institute believes, however, that government intentions to make the new regulator 'user-focused' should be fully expressed in the Bill. Unless amended the Bill may limit the Care Quality Commission's credibility and effectiveness.
3. The Picker Institute's three principal areas of concern are that the Bill:
· does not clearly state the principal duty of the Care Quality Commission
· does not reflect the government's stated commitment to the involvement of patients, service users and the public in the work of the regulator
· does not clearly mandate a role for the Commission in continuous quality improvement.
The principal duty of the Care Quality Commission
4. The Picker Institute believes that the Bill should be amended to state that the principal allegiance of the Care Quality Commission is to the interests of patients, service users and the public.
5. The government has stated that: "The Care Quality Commission('s)... priority will be to safeguard service users and help improve their experience of health and adult social care services." It has affirmed that: "Patients, service users and the public as a whole therefore look to... regulators to ensure the services they use are safe and of good quality."
6. The eventual Act should have a similarly strong statement of the will of Parliament regarding the Commission's main priority. The Bill should begin by clearly stating a principal duty for the Commission, mandating it to serve the interests of patients, service users (and their carers) and the public.
7. This amendment would:
· clarify what parliament wants the Commission to achieve, not just what functions are assigned to it: parliament should say what the Commission is for, not just what it does
· give the Commission a clear mandate to act on behalf of patients, service users and the public
· give consumers and potential consumers of services an explicit assurance that the regulator is acting on their behalf
· enable the Commission to resolve conflicts of interests between stakeholders
· protect the Commission's user-focused decisions from legal challenge.
Patient, service user and public involvement
8. The Health and Social Care Bill should require the Care Quality Commission to involve patients, service users and the public in its work.
9. This was a key theme from the preceding public consultation:
"..... many responses supported the greater input from patients and users of services proposed in the consultation document. Responses were very clear that participation needed to be based around genuine involvement, using a variety of methods in order to promote equality and proper representation of the interests of patients and users of services....."
10. In its response to the consultation, the government stated:
"The Care Quality Commission will be a user-focused organisation. Its priority will be to safeguard service users and help improve their experience of health and adult social care services - recognising that it can only do this effectively by involving them. It will be able to build on the good work by the Commission for Social Care Inspection, the Healthcare Commission and the Mental Health Act Commission, which all emphasise the importance of involving service users, and their carers, in their work." [our emphasis]
11. Within this Bill, the Office of the Health Professions Adjudicator (sections 101 and 102) and the Council for Healthcare Regulatory Excellence (subsection 108(4)) are given duties to consult the public, including bodies which represent the views of patients.
12. In contrast, the Bill requires the Commission only to have regard to 'views expressed by members of the public about activities to which (its) functions relate'. It does not require patient, service user or public engagement in its work.
13. The Bill should be amended to require the Care Quality Commission to:
· involve patients and service users in its work wherever possible, including regulation, review and inspection processes and activities
· work with patients, service users and members of the public in developing its work programmes, significant guidance documents and review and inspection methodologies
· consult patients, service users and members of the public regarding its functions and activities.
14. Without this requirement there is a risk that successful and highly regarded models developed by the existing regulators will be lost, along with executive-level commitment to best practice.
15. The Commission could, for example, be required to consult and take advice on its plans and processes from an advisory committee representing patient and service users. Such a committee (or another such high level mechanism) could research and consult with wider networks of user groups and representatives, as required. This would extend the reach of consultation and involvement, and so build confidence in the Commission as regulator.
The Commission's role in continuous quality improvement
16. The Health and Social Care Bill should mandate the Care Quality Commission to contribute to the continuous improvement of the quality of health and adult social care services.
17. In his Foreword to the government's formal response to the consultation, the Secretary of State for Health said that:
"The new system will make clear to the public what they should be able to expect in terms of safety and quality from their services and will support the work of those delivering them ...... in improving standards".
18. The Bill does not require any health service body in England to respond to the Commission's review and inspection reports, and does not require the Commission to provide support to service providers in improving quality standards. There is, essentially, a 'disconnect' between the Commission and its functions and the role of Strategic Health Authorities in performance managing service providers.
19. The Picker Institute understands that the government expects commissioning to be the principal mechanism that continually drives up the quality of health and adult social care services. However, it is widely recognised, not least by the Department of Health itself, that PCTs are far from delivering 'world class commissioning', which leaves a dangerous gap in quality assurance. There should therefore be a complementary quality improvement mechanism. The Commission's review and inspection findings, properly used, should play that role.
20. The Bill should be amended to give the Commission the authority actively to follow up its review and inspection work. Under-performing bodies must be required to develop, implement and monitor a local action plan for quality improvement.
21. The Commission should be mandated to work with, and require co-operation from:
· the Board of an under-performing reviewed body
· the Board(s) of agencies that commission relevant services from the reviewed body.
22.The Bill should explicitly require the Commission to ensure or encourage, as appropriate:
· use of its review and inspection findings to secure continual improvement of the quality of the services and activities to which the Commission's functions relate
· in all regulated services and activities, a focus on patient, service user and public needs and on people's experience of being in receipt of services.
23. Without such a mandate, the Commission's efforts and resources may be overly focused on eliminating the poorest performing service providers. With such a mandate, the Commission would be uniquely placed to contribute to the overall improvement of health and social care service quality over time.
About the Picker Institute
24. The Picker Institute is a charity, which works with patients, professionals and policy makers to promote understanding of the patient's perspective at all levels of healthcare policy and practice. It undertakes a unique combination of research, development and policy activities which together work to make patients' views count. It is acknowledged as a leading authority on patient and public involvement in healthcare, and has substantial experience of engaging service users to work with NHS Trusts to improve the quality of their services.
 Par 4.3, The future regulation of health and adult social care in England: response to consultation, DH, 2007
 Ibid, executive summary
 The future regulation of health and adult social care in England: response to consultation, says the Commission should pursue flexible, responsive, high-quality care that is safe, effective and personalised for all. Department of Health. October 2007. Foreword p4.
 Ibid Section 2.6 p16
 Ibid Section 4.3 p37.
 Ofcom has a 'Consumer Panel' that plays similar roles, and which convenes a regular 'consumer forum' of interested parties such as consumer and disability organisations.
 The future regulation of health and adult social care in England: response to consultation. Department of Health October 2007 Foreword p4