New head of Care Quality Commission takes aim at unsafe services

When David Behan takes over as chief executive of the Care Quality Commission next month he has a chance to overhaul the health and social care regulator

According to its website, the role of England’s Care Quality Commission (CQC) is “to check whether hospitals, care homes and care services are meeting government standards”. Cue image of person with clipboard, ticking boxes and possibly running a rubber-gloved finger round a toilet bowl.

Now consider the formal response of David Behan to his appointment last Friday as the CQC’s new chief executive: “I am delighted to have been given this opportunity to lead the organisation that takes action where services are poor and unsafe, whilst providing assurance that our health and care services achieve quality and outcomes for people which are amongst the best in the world.”

Clearly, the emphasis of the new regime at the CQC is that it should be an outfit that “takes action where services are poor and unsafe”. No more buckpassing of the kind we saw in the Winterbourne View scandal, when a whistleblower’s warnings of abusive treatment of learning disabled people in the private hospital near Bristol failed to trigger intervention.

Note, too, the stress on “quality and outcomes”. Although there will be no return to the old system of star ratings or any other ranking by CQC inspectors – care provider groups are working on their own systems – there is more than a hint here of a shift from box-ticking to assessment of services according to what they do for the people who use them.

Behan arrives from the health department, where he has been director general of social care since 2006. Prior to that he was chief inspector of the Commission for Social Care Inspection, one of the three bodies melted down to form the CQC in 2009. He has worked in and around social care since 1978 – a wealth of relevant experience, although, as we see in respect of solicitor Tom Winsor, the Home Office’s preferred candidate for chief inspector of constabulary, no career experience whatsoever may be deemed an advantage in a regulator these days.

What Behan does not have is a healthcare background. This explains the muted reaction to his appointment from the NHS, in contrast to the broad welcome from the social care world. But big health names failed to step forward for the job, viewed widely as a poisoned chalice, and Behan’s track record in the department will have ensured he had no shortage of willing referees among senior NHS figures.

He did think long and hard before applying. Who wouldn’t? The CQC has taken an enormous pasting, not always justifiably, and there is general agreement that the remit it accepted in 2009 was undoable on the resources it was given. But Behan will have a singular opportunity to change the terms of the game when he moves next month.

Following the health department’s capability review of the CQC that hastened the resignation of Cynthia Bower, whom Behan is replacing, the organisation has been set three core challenges: to become more strategic in its approach and define more clearly what successful care provision looks like, not least by reference to quality and outcomes; to strengthen its own board to clarify accountabilities, almost certainly by including the chief executive and other senior staff on it; and to make its regulatory process more systematic, consistent and proportionate to the level of risk in different parts of health and social care.

Of these challenges, which the CQC is tackling through a strategic review, the toughest will be the third. As one experienced observer puts it: “The big problem is the CQC has never understood risk. It doesn’t mean: ‘Have people completed the paperwork?’ It means: ‘Is this an inherently risky situation for a person to be in?’ If you don’t get that, you don’t get it at all.”