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The Dash Review: the future of the CQC

Steve Brine @BrineHealth is a Strategic Adviser at GK Strategy. He was a Health Minister (2017-2019), Government Whip, and is a former chair of the Health & Social Care Select Committee. Here, he reflects on the future regulatory landscape for adult social care.  

Context is everything when it comes to social care. Well, almost everything because you can’t forget the politics. On one hand, despite a grand pledge in the Labour Party manifesto to “undertake a programme of reform to create a National Care Service”, we have nothing happening at all. 

On the other we have the Dash Review (and now Dash 2.0), the Ten Year Plan, the next phase of the spending review and of course, the Budget which brought a further £600m to prop up the service. 

Taken on face value, a national care service is of course a very (very) big deal. This could literally mean the nationalisation of the entire social care sector – akin to how local voluntary hospitals were brought under national public ownership in the 1940s – or it could mean, well, whatever you want it to. Perhaps that’s the point. The truth is, right now, we’re none the wiser and nor I suspect are Ministers. 

More immediate, not least for investors and those looking for a little certainty in the sector, is the major NHS Ten Year Plan consultation launched last week. As I understand it, everything is in scope for this programme of work led by Paul Corrigan and Sally Warren with the exception of, wait for it, adult social care. Meanwhile, the Dilnot reforms have been kicked down the road (again) which means the spending cap will now not be introduced next year as planned. Andrew Dilnot is reportedly furious and the great immovable object of NHS reform seems further away than ever before.  

What we do know is Penny Dash is in the ascendancy with this government. Shortly after Lord Darzi produced his 163-page diagnosis of the NHS, Dash published her full report into the operational effectiveness of CQC. The Dash review found significant failings in the organisation which it said ’has lost credibility in the health and social care sectors’ and led Wes Streeting to say it was no longer fit for purpose. It found that the CQC’s ability to identify poor performance and support quality improvement has deteriorated and says this has undermined the health and social care sector’s capacity and capability to improve care. 

Alongside Dash, a parallel review was led by Prof Sir Mike Richards (former chief inspector of hospitals) looking at CQC’s controversial single assessment framework. Sir Mike (one of the best officials I worked with while a Minister) recommends a fundamental reset of the organisation and a return to the previous organisational structure, with at least three chief inspectors leading sector-based inspection teams at all levels. 

And as if that weren’t enough, Dash gets a 2.0 moment as this month we learn the way patient safety is regulated and monitored is to be completely overhauled in England. With the swoosh of a Minister’s pen; the CQC, the National Guardian’s Office, Healthwatch England and local Healthwatch services, the Health Services Safety Investigations Body, the Patient Safety Commissioner and NHS Resolution are all set to be reviewed. 

Whatever the future of Henrietta Hughes (the Patient Safety Commissioner) or Helen Vernon (who leads NHS Resolution) one name here is to stay is Julian Hartley. Currently Chief Executive of NHS Providers he will take over as the head of the CQC in December. Julian is a smart appointment. A nice guy (but don’t be fooled) who exudes calm and is fiercely organised. He will find an organisation on its knees and I am sure a massive rebuild on his hands. 

It is clear that Penny Dash has listened to the voices of care providers, resulting in a clear set of recommendations so Julian Hartley will benefit from that oven-ready piece of work. Equally, I suspect the Richards review findings will not meet too much resistance. Expect a re-set to a standardised approach to inspections and for line management of such to come back under the auspices of the Chief Inspector of Hospitals. I wouldn’t be surprised to see a completely re-born and re-branded CQC that focuses on safety as well as efficiency, outcomes and use of resources – you can be sure Rachel Reeves will make that a red line. 

Ministers will, in my experience, find that the desire to do the Ten Year Plan minus adult social care doesn’t survive contact with political reality. And so between now and the Spring, and indeed the final throes of the comprehensive spending review to come, furious negotiations between DHSC, Angela Rayner (who is responsible for council funding) and HMT are the order of the day. 

And when all is said and done, we will find out whether the work of change has great substance or everything looks and feels very familiar. 

Big Ben in London

Post-Budget Webinar with the Rt Hon David Laws

GK Strategy Event

GK Strategy would like to invite you to: Post-Budget Webinar with the Rt Hon David Laws

The webinar will focus on the measures contained within the Budget, including what it means for the government’s policy priorities, businesses and the investment community moving forward, as well as what happens next.

There will be an opportunity for a Q&A at the end of the session.

Keynote speaker:
The Rt Hon David Laws – Former Chief Secretary to the Treasury and Minister of State for Schools

Thursday 31st October | 9am-10am

(the briefing will begin at 9:05am)
The event will be held virtually. Please RSVP by emailing events@gkstrategy.com for joining details.

 

The Rt Hon David Laws is a strategic adviser to GK with a wealth of experience across the policy and politics of education and skills.

Between 2001 and 2015, David served as the Liberal Democrat Member of Parliament for Yeovil. He held various senior frontbench positions for the party in Parliament, including as its spokesperson on schools, children and families, before joining the Cabinet as Chief Secretary to the Treasury in the Coalition Government. From 2012 to 2015, David was the Minister of State for Schools in the Department for Education.

He has served as Executive Chairman of the Education Policy Institute and the Education Partnerships Group. In December 2022, David was appointed chair of Energy UK, a post he started in early 2023.

Group of women having a meeting

Roundtable discussion: Local authority funding and its impact on the future of social care

Images: Seb Wright Media

For a roundtable event held in July 2024, hosts Hannah Haines (Head of Healthcare Consultancy, Christie & Co), Michâela Deasy (Head of PR & Comms, Compass Carter Osborne) and Lizzie Wills (Senior Partner & Head of Private Equity, GK Strategy) were joined by some of the biggest female names in the UK social care sector.  

The roundtable brought together operators, lawyers, investors and sector experts, all of whom share a passion for quality healthcare and for driving an increased awareness of the challenges faced by operators as a result of funding challenges across the country.  

Below are some of the key highlights from what was discussed around local authority funding and its impact on the future of social care.  

According to the Local Government Information Unit, 50% of local authorities (LAs) have reported that they are likely to be bankrupt in the next five years, with 9% predicting they would be bankrupt in the next 12 months. This is already the case for a number of LAs, including Birmingham. These struggles are not going to be resolved without fundamental reform – of how services are delivered at a local level, or how they are funded.  

To address the funding challenges they are facing, most LAs have identified areas to make direct cost savings. For example, many have confirmed that they will make budget cuts relating to parks and recreational spaces. Although this may not directly impact the social care sector, it could end up affecting the mental health of the communities that rely on these facilities. Meanwhile, 16% of LAs said they are looking to reduce spending in adult social care, 12% in children’s care services, and 10% in SEND, though statutory services will be better protected from funding cuts.  

… For the full article on the Christie & Co website, click here.  

To find out more about the team’s next roundtable event, contact Michâela Deasy: michaela@compasscarterosborne.com 

The view from Westminster in London

GK Strategy – General Election Update

General Election Results Briefing

The GK team reacts to the 2024 General Election results, with GK’s Strategic Advisers sharing their insights on Labour’s historic victory, and the implications for Sir Keir Starmer’s new government.

To read our briefing please click here.

Is Starmer Taking a Risk in His Attempt to Broaden Labour’s Appeal?

GK Advisers Noureen Ahmed and Felix Griffin reflect on Natalie Elphicke’s defection to the Labour Party and what this could mean for the Labour Party ahead of the next general election.

Keir Starmer is keen to exploit divisions within the Conservative Party, but is that enough to convince voters that Labour is a government in waiting?

When MPs took to the Common’s chamber for Prime Minister’s Questions on 8 May, we witnessed Natalie Elphicke defect to the Labour Party – the third Conservative MP to do so during this parliament. As a right-wing MP and vocal critic of Labour’s policies, Elphicke’s defection came as a huge shock to many in Westminster. Elphicke has previously accused Labour of being soft on issues related to human rights and immigration. As a result, there have been concerns from several Labour MPs that Labour’s commitment to tackling those issues could be undermined by her admission to the Party. Starmer’s willingness to embrace a defector from the right of the Conservative Party suggests a strategy aimed at broadening Labour’s appeal to Conservative voters, even if it means alienating the party’s left flank and risking Labour’s reputation on key issues such as social justice. This approach has sparked awkward questions about how far Labour’s leadership is willing to go to win Tory votes.

Labour’s strategy may be effective in the short term, creating a perception of decay within the Tory government and encouraging Conservative voters to switch allegiance. However, the success of the Greens and some independent candidates in recent local elections indicates that anti-Tory sentiment does not necessarily translate into enthusiastic support for Labour. To be truly successful, Labour will need both an appealing policy platform to secure votes at the general election and firm support across parliament.

While further defections may seem unlikely, they should not be ruled out entirely. As Sunak continues to face criticism that he is leading an increasingly chaotic government, it is evident that Labour will do everything it can to secure the victory it has long yearned for.