The establishment of the Care Quality Commission

5. The Health and Social Care Bill, which is at present going through Parliament, establishes the Care Quality Commission (CQC). This is to be a new independent body responsible for regulating services across the health and adult social care sectors which spend over £100 billion of public money and involve about 2.9 million people employed in delivery of services in over 25,000 establishments.[3]

6. The CQC proposed in the Bill will replace three existing regulators: the Healthcare Commission, the Commission for Social Care Inspection, and the Mental Health Act Commission. As attempts are made to integrate better the provision of health and social services, the case for an integrated regulator becomes more powerful. The Department of Health informed the Committee that "an integrated and flexible regulatory system will help provide the consistency and assurance that the public expects; enable local service innovation; and support local accountability".[4]

7. Subject to the passage of legislation, the Commission will be created in October 2008 to take over from its three predecessor bodies from 1 April 2009.

8. According to the Department, the new body will have four broad functions across England:

"Safety and quality assurance of health and adult social care services (registration of public, independent sector (including third sector and social enterprise) health and adult social care providers; monitoring compliance with registration requirements and taking enforcement action if these are breached; conducting further inspections, investigations or reviews of services);

Monitoring and keeping under review the operation of the Mental Health Act 1983 and related functions (visiting detained patients, arranging for specific treatment safeguards under that Act; monitoring the application of the deprivation of liberty provisions in the Mental Capacity Act 2005);

Periodic reviews of providers and commissioners (ensuring good quality information is available to support choice by people who use services; also publishing comparative information about health and adult social care commissioners; providing an annual report to Parliament on the state of health and adult social care and the operation of the Mental Health Act); and

Minimising the burden of regulation and inspection (coordinating and reducing duplication of inspection-related activity across health and adult social care; taking on new 'gate-keeping' functions, which are designed to reduce the administrative burden of regulation; working with other bodies).

By carrying out its functions, the Commission's overarching focus should be to help protect and promote the health, safety and welfare of people who use health and social care services."[5]

9. In addition, the Department's note to the Committee adds:

"the Commission should perform its functions for the general purpose of encouraging continuous improvement, efficiency and a focus on those who use services.

The Commission will also be expected, in carrying out its functions, to:

demonstrate effective involvement of those who use services by taking into account views and levels of satisfaction amongst those affected by its activities, particularly people who use care services;

take account of the need to protect and promote the rights of people who use health and social care services—in particular, those of children and vulnerable adults;

ensure its actions are proportionate to the risks against which it affords safeguards; and

take account of best practice amongst other organisations performing similar regulatory functions and any future developments in approaches to inspection or regulatory action."[6]

The Role of the Board

10. The Commission will be led by a small non-executive board of Commissioners with a Non-Executive Chair. The precise size of the board is yet to be decided.

11. Since the organisation will have a broad range of responsibilities spanning interests in health and adult social care across the public, private and voluntary sectors, the board will be expected to present a range of skills and experience.

12. The Department has stressed that the Board will provide leadership and governance for the organisation. Their key duties will be to:

"provide strategic direction and set operational objectives in line with national policy and legislative guidelines;

set and maintain the values for the organisation and ensure that its obligation to all stakeholders, including service users and the Secretary of State, are understood and met;

monitor the achievement of objectives through a framework of effective financial and quality management to ensure effectiveness and value for money;

collectively promote the effectiveness and success of the Commission; and

promote and contribute to best practice and knowledge transfer across the sectors it oversees."[7]

The Chair

ROLE

13. The Chair will provide leadership on the board of the Commission and, according to the Department, will have a very significant impact and influence on the success of the organisation. The Department informed us that:

"the person we are looking for will be able to demonstrate:

senior board level experience in a complex organisation with high personal standards in relation to governance and assurance;

leadership and motivational skills and, particularly the ability to create and lead a team of high performing people to achieve shared goals;

an understanding of regulation in either the public or private sectors with the commitment to improve health and adult social care through effective regulation;

the capacity, drive and enthusiasm to lead the creation and establishment of a new organisation and develop it as a cost-effective model drawing on their experience in the public or commercial sector;

the ability to operate creatively and with flexibility in a statutory framework;

the ability to understand and address high profile, complex and sensitive issues;

experience of building and sustaining positive relationships with key stakeholders at all levels of government and the public sector; and

an understanding of diversity issues, equal opportunities and human rights issues and a commitment to applying these principles to the work of the Commission."[8]

14. The Chair will be appointed (and may be removed) by the Secretary of State for Health and will:

ensure the success of the Commission by developing, with others, a vision for the effective regulation of health and adult social care services within the Commission's remit;

assist the transfer of work to the Commission by working collaboratively with the Department of Health and the Chairs and boards of the existing Commissions;

ensure that the new organisation retains the confidence of people who use services, service providers, the wider public and Ministers—reporting annually on a number of matters including laying its annual reports before Parliament and sending copies to the Secretary of State;

take part in the selection of the Chief Executive, Non-Executive Board members and other key staff as appropriate; and with them,

develop plans for delivering the Commission's functions.[9]

15. The Chair will be expected to undertake the following duties:

chair full board meetings;

ensure that the Chief Executive is held to account for the performance of the organisation and his/her accounting officer role;

ensure that the Commission carries out its statutory functions having regard to such aspects of Government policy as the Secretary of State may direct;

ensure that the Commission complies with all other statutory and administrative requirements for the use of public funds.[10]

16. With the Chief Executive, the Chair will:

represent the Commission in its dealings with Ministers;

represent the Commission at national level; and

develop links with appropriate stakeholders and organisations representing people who use services.[11]

THE TRANSITION PERIOD

17. Subject to the passage of legislation, the Commission will be formally established in October 2008 and commence operations in April 2009. This means the bodies that the Commission will replace—the Healthcare Commission, the Commission for Social Care Inspection and the Mental Health Act Commission—will continue to operate their current statutory functions until the end of March 2009.

18. The Department has emphasised that a vital task for the new Chair, Commissioners and Chief Executive will be to focus on the establishment of the new organisation, at the same time working constructively with the existing Commissions to ensure that the transition from current to new arrangements is effective and achieved with minimal risk and disruption to regulatory functions.[12]

TERMS AND CONDITIONS OF SERVICE

Time commitment and remuneration

19. The post of shadow Chair of the Care Quality Commission was advertised from Wednesday 13 February in various national newspapers. The advert indicated that the Chair of the Commission would receive up to £60,780 a year for up to three days a week. More may be available for an exceptional candidate. During the period leading up to the Commission's formal establishment in October 2008, the exact number of days per week will be negotiated with the successful candidate.

Appointment and Tenure of Office

20. The Chair is appointed for a period of 4 years by the Secretary of State. The appointment may be renewable for a further term.

21. This role is a public appointment to a statutory office not employment or a "job". It is not subject to the provisions of employment law and has no contract of employment.[13]

22. The Department stressed that as a public appointee, the "Chair must demonstrate high standards of corporate and personal conduct and maintain public service values in the discharge of your duties". In addition, any conflict of interest that arose in the course of board business must be declared as must any relevant business interests, positions of authority or other connections with commercial, public or voluntary bodies. These would be published in the Commission's annual report with details of all board members' remuneration from public sources.[14]

23. The advert indicated that in line with Government proposals to increase Parliamentary scrutiny of appointments to key posts, the preferred candidate for the post of Chair might be required to appear before a Parliamentary Select Committee prior to appointment.

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14   Ibid Back