Despite the landscape of health and social care changing, the fundamentals of regulation remain unchanged; it was, and still is, about the people receiving services. Regulation is there to ensure people have safe, high-quality care. It illustrates what ‘good’ looks like, encouraging care services to improve and holding them to account.
There have been several key moments. Acts of Parliament have been passed, including the Health and Social Care Act 2008, which joined together the Healthcare Commission, the Commission for Social Care Inspection and the Mental Health Act Commission in 2009 to form the CQC.
I spoke to colleagues about their reflections of the last two decades.
Jane, an inspector of adult social care, said, ‘The regulations have been the backbone of our work, but the real essence is how care is perceived by people. It’s about people receiving care and support in a safe situation. It’s also about people having the freedom to make choices and decide how they want to receive support. This hasn’t changed in 20 years.’
Jane pointed to the importance of our responsibilities around the overview and assessment of how the Mental Capacity Act is implemented. ‘This gave us a much-needed power. It helped to make sure that even when people can’t make all decisions for themselves, they are still treated as individuals with pasts and personalities that are unique to them. The monitoring of “best interests decisions” has really helped to make sure decisions truly are made in the person’s best interests. This has given us the legal backing to really promote person-centred care for everyone, regardless of their ability to articulate their wishes.’
Collaborative approach
Understanding and reflecting on people’s experience is central to our work. We’re proud to work alongside our Experts by Experience (ExE) in much of our regulatory activity. The ExE role helps us to hear the voices of people who use services during inspections, Mental Health Act visits and monitoring activity. In the last year (1 April 2022 to 31 March 2023), ExE were involved in 4,141 regulatory activities and talked to approximately 40,520 people. Our ExE provide a valuable lens that enables them to share insight with our teams. This will become even more important as we change our ways of working, in ensuring people’s experience of services remain central to what we do.
Co-production remains embedded in everything we do and involves our colleagues, people who use services, providers and strategic stakeholders. By engaging a range of voices, we ensure we’re accurately representing the needs of people we serve.
New ways of working
We’re always looking forward. We’re in the middle of a significant transformation to deliver our ambitious strategy. We’re making sure we continue to meet the needs of ever-changing sectors, understand the quality of care in a local area or healthcare system to improve it and keep people safe.
Our move from generalist to specialist inspection teams several years ago was a game changer, and we’re preserving and developing that specialist approach within our new Integrated Assessment and Inspection teams. This gives us the best of both worlds, as our adult social care inspectors work alongside colleagues focusing on acute, secondary, community and primary care across a local area.
We continue to actively work to reduce inequalities in health and care. Our new single assessment framework, assessments of local authorities and integrated care systems are built on the same quality statements, embedding the voice and experience of what matters to people and their families, but helps us to better regulate the changes in systems and commissioning of recent years.
I’m confident that dedicated and passionate colleagues will continue to do all they can to raise the profile of health and social care and reiterate its importance to and value in society. And that all of us involved in health and social care in England will continue to work to ensure people are able to live their best lives. That hasn’t and won’t change.