Getting The Balance Right

Care Appointments caught up with Professor Frank Clark, the new Convener of the Care Commission, who outlined his view of what a responsible regulator should be like…

Professor Frank Clark enjoyed a long and distinguished career in the NHS, and recently took up the post of Convener of the Care Commission. This was not a step he took lightly and the thought processes, the research and the cognitive reasoning that he immersed himself in before committing to the post give one some idea of the mark of the man.

Care Appointments asked Professor Clark to give us an idea of the path that had led him to the top job in the regulation of Scottish care services.

“I served for 31 years in the NHS and retired aged 50, having been Chief Executive of a large health authority, and I wanted to do something completely different. It was a life decision for me to make that change. The world of palliative care has always interested me and the opportunity to become director of Strathcarron Hospice came along.

“When I believe in something strongly I become something of an evangelist and in the palliative care world I started to become involved on a national level, in both Scottish and UK terms. Because palliative care was something that was relatively poorly understood I could see that there was a role for someone like me to get out there and be the champion and I hope that I did that successfully as chairman of the Scottish Partnership for Palliative Care and through the cross-party group on palliative
care in the Scottish Parliament.

“I was appointed to the post at Strathcarron in 1996 and I said I would do it for ten years and in December last year I indicated to my management that I wouldn’t be seeking to go on beyond October 2006. Just as my decision to come out of the NHS wasn’t taken lightly, neither was my decision to leave Strathcarron – it was a wonderful post, one that I thoroughly enjoyed, but ten years is a long time to be in any job and the time was right for me to make a change.

“I then started turning my mind to what else I might do. I felt that given my background – chairman of a health board, chairman of an NHS Trust, headed up a Ministerial task force – I felt that I had skills that could be of help in a non-executive capacity. I also have a particular interest in corporate governance and I’ve done a bit of work for the Chartered Institute of Public Finance and Accountancy, so I proceeded to find out what positions were available.  

“I discovered that the Care Commission were looking to appoint a Convener, so I got the particulars, I did my homework on it, and spoke to the headhunters. I also spoke to a number of relevant people that I’d got to know during my time at Strathcarron and while wearing my national hat in palliative care, where I worked in close conjunction with the Care Commission as we developed the national standards for hospice care and the regulation and inspection regime for hospices.

“So I’d had a lot of exposure to the Care Commission and it seemed to me to be an organisation that had a good reputation and performed what I regard as a vital role – as a non-departmental public body we have a high level of visible accountability of the most practical and focused sort.”

There were a number of dimensions of the role and the organisation that appealed to Clark, as he explains:

“The people who use the services that we regulate expect that the Care Commission will be a responsible regulator – in short, when they see a certificate that bears the Care Commission logo and a signature, this effectively certifies that this is a safe and acceptable place or service in which to entrust the care of your loved one, whether it’s children at one end of the spectrum of very elderly people at the other. In essence, it’s an organisation that’s responding to the needs of the most vulnerable within our society.

“I was impressed with the work that the Care Commission had done on their consultation exercise – I thought that was an absolutely superb piece of work because so much engagement with the public can be tokenistic and what the Care Commission had done was to close the loop, they’d gone and asked people their views and then they said ‘this is what we’re going to change in response to what you’ve told us’ and then fed that back to people.

“The second dimension that struck me as being important was having credibility in the eyes of those who deliver services. I think that a responsible regulator should be resolute without being draconian – that means working with individuals to effect improvement. The notion of ‘regulation for improvement’ was something that particularly pleased me – the idea being that it’s not simply about ‘ticking boxes’ but rather working with service providers to ensure that services are constantly improved, to be aware of what good practice looks like and to commend good practice to individuals.

“That was a dimension of the job that particularly appealed to me – working with providers, gaining credibility with them, showing them that the Care Commission understood the world in which the provider was functioning and that this was not some remote, arms-length organisation, but one that was engaged and actually wanted the same things that they wanted: the best for their clients and their patients.

“The third dimension was credibility at a political level – credibility in the eyes of the Ministers with whom we work. Ultimately we’re a non-departmental public body, we’re accountable to Ministers and it’s very important that we’re able to demonstrate to the Ministers the value of good regulation and that we’re actually regulating in an effective manner.

“The combination of all of these factors and dimensions was what attracted me to the post so I looked at my own skills and thought ‘is there a fit there?’ and it seemed to me that there was a fit.”

Clark’s use of the words ‘resolute without being draconian’ in his description of what a regulator should and should not be is both insightful and thought provoking. We asked what thoughts he had on how the Care Commission should best communicate its desire to work ‘with’ the sector and the workforce, and avoid being perceived as a shadowy ‘big brother’ type figure.

“Being resolute is important – we have to be seen as an organisation that will not allow poor standards to continue but we’re willing to accept that sometimes people need help and support to improve their standards. The impact of any intervention on our part is not just an impact on the service provider but it has social consequences for the people who use the services. Closing down a care home, for example, is not something that we would embark upon lightly because, after all, it is home for a number of people.

“There is a balance to be struck between working with someone to effect improvement (provided there is clear evidence that they are working towards that), and taking enforcement action where it’s clear that, despite our best efforts, someone is not willing to do that.

“Finding ways to have mutually beneficial engagement with individuals and with care providers is a fundamentally important part of demonstrating that we’re a regulator that’s in-tune, rather than a regulator that sits behind a set of national standards and ticks boxes.” {mospagebreak}

Although he is still new to the post, Clark is clear on what his priorities are for the coming months as well as those of the Care Commission itself.

“For me, assimilating is a key priority. Getting out and about and meeting regional teams is a priority. Ensuring the effective governance of the organisation is also a priority. I think that there is a major health and social care agenda operating in Scotland at the moment and the Care Commission, as part of its function as a regulator, can contribute to that and this is opening up the avenues with the Scottish Executive (in particular in the Health Department) and looking at the knowledge that we have here and how we can use that knowledge to contribute to the development of the wider agenda.

“You could describe this as the ‘added value’ that the regulator brings – not simply sitting there with all this information locked up but making the information available for other purposes and helping to inform and develop an exciting health and social care agenda in Scotland.”

Clark’s vision for the Care Commission is one of ‘a responsible and credible regulator’ working along with other regulatory bodies. He cites the Scottish Social Services Council, the Social Work Inspection Agency and NHS Quality Improvement Scotland as organisations with whom the Care Commission enjoys close and effective working relationships.

“We have to continue to build relationships with these bodies to ensure that there isn’t duplication or, worse, gaps in the regulation process, and to ensure that the burden of the regulation is reasonable in all circumstances and that does mean working with these other agencies closely and not operating in splendid isolation. It also means building the right kind of relationships with local authorities, the right kind of relationships with NHS boards and promoting a greater awareness of the role that we have to play and therefore the contribution that we might make both nationally and locally.”

There are those, of course, who suggest that there are too many regulatory bodies operating within the confines of the Scottish care sector, but while the Care Commission have contributed to the review of scrutiny of public services being conducted by Professor Lorne Crerar, Clark is not one who shares this view of ‘too many cooks’.

“We look forward with interest to the results of the review, but I am less concerned about the number of bodies than I am about ensuring that these bodies work effectively together. I’m less concerned about frequency of inspection than I am about intensity of inspection because I think that that any kind of regulatory or inspection process has got to be risk assessed and the input into any given situation should take account of track record, numbers of complaints, any requirements that were imposed, any enforcement action and so on. It should always be appropriate and proportionate.”

Developing the subject of organisations working together, we asked Professor Clark if he envisaged the Care Commission getting involved in any cross-border collaboration or consultation with bodies such as the Social Care Institute of Excellence (SCIE) or at least taking cognizance and perhaps learning from the work that they are doing?

“I have a view that all care needs to move towards being evidence based. I was encouraged while reading the SCIE business plan 2006-2007 by the amount of research that they have done and are proposing to do. There was a section in the plan on knowledge management and knowledge transfer which something that we are looking at right now in Scotland.

“We can’t think parochially – we’ve got to open our minds to information that’s coming from other sources and a body like SCIE has got an extremely important part to play. While the bulk of their focus tends to be south of the border it doesn’t mean that we shouldn’t be alert to the work that they are undertaking and that we shouldn’t look at the relevance of that to our activities here in Scotland. There is no bartering in wisdom.

“Notwithstanding regulatory or legal frameworks, good care is good care and in the final analysis the only thing that matters is the perception of the individual receiving the care. If there is evidence that is developed elsewhere that can point out good practice then I have a philosophy which is that knowledge brings responsibility.”

Having made the transition from health care to social care one would assume that Frank Clark was bound to encounter some interesting contrasts and challenges…or maybe not.

“Interestingly enough, I have a little concern that there is a tendency to think of the health agenda and the social agenda as two separate entities – they are absolutely not and they have never been less so than they are today. Take the Kerr Report and Delivering for Health – I’ve seldom seen health reports which so overtly focus on the cohesion of the health and social care agenda.

“I would like to see us thinking much more in terms of the health and social care agenda rather than two separate agendas. It’s not a case that they overlap – one informs and is informed by the other. They are two sides of the same coin. This is an area where, already, I can see the Care Commission playing its part at a national level and contributing to that debate.”

Professor Frank Clark’s post as Convener is three years in duration, with the possibility of a further three years thereafter. We asked him, when his tenure does come to an end, what he would like to look back and see has been achieved by the Care Commission?

“I’d like to see a situation where the benefits of effective regulation were seen and acknowledged by everyone, that is by service users, by providers and by the legislators to whom we are accountable, so that regulation was not seen as some sort of imposition but rather seen as a necessary part of delivering effective care. I would like to see us fully integrated into the mainstream thinking in terms of the continually developing health and social care agenda. I would want to see us being able to demonstrate that what we do constitutes value for money because I think that’s fundamentally important – we’re spending £30 million pounds of public money and we have to be accountable for that.”

In Professor Frank Clark, the Care Commission has quite clearly recruited as their new Convener a man who is committed, highly experienced, honest, and, perhaps most importantly, thoroughly decent. The regulation of Scotland’s care services should be safe in the hands of Frank Clark.