Tag Archives: NHS

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.

GK Point of View – Tory and Labour priorities in 2024

GK Senior Adviser Robert Blackmore and Adviser Noureen Ahmed assess the priorities for the Conservatives and Labour in 2024 as we make our way closer to a general election.

The Tory plan to build back core support

The Conservative Party begins 2024 in dire straits, over 20 points behind Sir Keir Starmer’s Labour in the polls, they are running out of time to avoid a chastening defeat. Party leaders are therefore concentrating their efforts on ensuring they have strong support with the Party itself, while strategists desperately try to home in on the clearest path to victory, reducing illegal immigration via the Rwanda scheme, and providing tax cuts.

Much of the Government’s political capital is being spent on making its plan to send some asylum seekers to Rwanda for processing a reality. The updated Rwanda Bill has now reached the House of Lords, where intense opposition is expected. For party strategists, it provides the Conservatives with an opportunity to weaponise the debate and highlight the immigration and Brexit-related tropes that dominated the political debates in the late 2010s.

However, the political salience of the small boats issue to the wider country, as opposed to the party’s rank-and-file, is not yet clear. That is why the Party is so keen to ensure voters feel economically empowered, as the next election approaches. With the Spring Budget scheduled for 6th March, there are a number of tax cuts that Chancellor Jeremy Hunt has been considering in recent weeks, including further cuts to national insurance, cuts to income tax, and an increase in the child benefit threshold. The Chancellor, however, has been managing expectations about how feasible these may be, with the likelihood that the degree of fiscal headroom in March will be lower than expected. A fourth category, cuts to inheritance tax, is also now deemed less likely, as the Prime Minister fears it could be portrayed as a tax concession to the wealthy.

Yet, such a strategy is dependent on the electorate’s support for the Government after 13 years in power. Will they show gratitude to the Government for providing extra pounds in their pocket and vote accordingly? The tax burden is the highest it has been since the Second World War, and, according to the Resolution Foundation, wage stagnation represents a real-term decline in take home pay for many households since 2008. Given these challenges, it is not guaranteed that the Conservatives’ strategy will cut through.

It’s in the bag for Labour surely?

As the next general election looks increasingly likely for late Autumn, the Labour Party is planning to finalise any manifesto commitments by mid-February (in the unlikely scenario that the PM announces a May election). Although the Labour Party requires a significant electoral swing to claim a majority, it has been buoyed by recent polling indicating that Labour are firm favourites to lead the next government. As a result, many in Labour HQ are optimistically planning the Party’s campaign strategy.

In 2023, Labour Leader Sir Keir Starmer unveiled his 5 national missions that the party will build its manifesto around. Core missions include Labour’s ambition to support the NHS to get back on its feet and break down barriers to opportunities.

Unsurprisingly, education has remained at the forefront of Labour’s core priorities, with the Party recently unveiling its plans for schools, further education, and the early years space. The Party is determined to introduce reforms to support the development of young people and better prepare them for adulthood.

The NHS is regarded as an area of strength for the Party, with the public almost always preferring Labour’s handling of the NHS. Given the widespread awareness of ongoing crises, such as doctors’ strikes, long waiting lists and inaccessible GPs, the Party is letting the national story do the campaigning for them, with scant few serious pledges on health and social care policy. Shadow Health Secretary, Wes Streeting, has promised to work to address the fundamental issues, with promises made by the Party to boost funding investment, cut down waiting lists and improve staff recruitment.

However, further information on reforms have not been made public – many at Labour Party HQ worry that a detailed proposal may just offer the Conservative Party a “free win”, by giving it something to critique. The manifesto will shed light on where their focus may lie on health, but it’s unlikely that Labour will reveal its plans in full before taking power. Nevertheless, Labour has now started talks with the civil service and is finalising policy. We expect Labour to accelerate its campaign plans and attempt to present itself as a calming presence in contrast to the continuing Tory storms.

GK Point of View: The NHS and Us

On the 75th anniversary of the National Health Service, GK Strategic Advisor and former Minister of State for Care Services, Phil Hope, reflects on the NHS in its current form and looks ahead to how the UK’s major political parties will position their offering for the health system. Find Phil’s commentary here: NHS 75th Anniversary