Health and Social Care Committee
Wednesday 9th September 2026
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09:32
Layla Moran
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Layla Moran
Welcome to this one off session of the Health and Social Care, where we are doing the Pre-appointment hearing of the chair of the Care Quality Commission, and it is very. My pleasure, very much my pleasure to welcome Baroness Julia Neuberger, who is the DBE, who is the preferred candidate of the government. Thank you so much for joining us this morning. May I start by I mean a bit of a preface. Ever since this committee has been meeting, and indeed, before that point, it's fair to say that the CQC has received significant criticism for its own performance.
We've had a number of different hearings with them over the years, at points feeling slightly more hopeful than not. But I must be honest, I start this appointment hearing feeling relatively down in the dumps that we haven't got further than we have. Could you explain to us and the public, why do you want to take on this role right now? You are questioning. My
We've had a number of different hearings with them over the years, at points feeling slightly more hopeful than not. But I must be honest, I start this appointment hearing feeling relatively down in the dumps that we haven't got further than we have. Could you explain to us and the public, why do you want to take on this role right now? You are questioning. My
09:33
Speaker 1
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Speaker 1
sanity, I think maybe, yeah. Okay. Let me let me start by saying I'm not sure I actually sort of really wanted it in that sense, but I am still, for the next couple of weeks, chairing two NHS trusts. UCL H, which is a foundation trust, and Whittington Health, which isn't. I have experience of the CQC from the user end. If you like organisations which are inspected by the CQC and the experience has been singularly mixed, I'd say I.
And the thing that I feel most strongly about is. And this is, I suppose, a public service point, we do have to have a really effective and trusted and respected regulator in health and social care. It doesn't have to be loved, but it does have to be respected , and its inspectors have to be respected. And that's not the case at the moment. I mean, it's better than it was, I have to say, it's certainly better than it was a year ago.
18 months ago, perhaps I should say. But it's still got an awfully long way to go.
And the thing that I feel most strongly about is. And this is, I suppose, a public service point, we do have to have a really effective and trusted and respected regulator in health and social care. It doesn't have to be loved, but it does have to be respected , and its inspectors have to be respected. And that's not the case at the moment. I mean, it's better than it was, I have to say, it's certainly better than it was a year ago.
18 months ago, perhaps I should say. But it's still got an awfully long way to go.
09:34
09:34
Speaker 1
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Speaker 1
It's not one thing I think I would say, and some of this is happening. So it began not to do nearly enough inspections. So it had this huge, great backlog, huge backlog of registrations as well. Then there was a sense within the service, whether that's fair or not, I can't judge, but there was a sense within the service that they were trying to catch up so that they weren't doing them, if you like, as sort of thoroughly as they might have done.
And also that reports of inspections were coming incredibly, coming back incredibly late, that people were finding that they got two different two different judgements at the same time. It just felt it felt chaotic. And I think if if it feels chaotic, you don't have respect. But I think it's I think it goes deeper than that. I think that's the question you're asking me, I think, and I'm not there yet.
And also that reports of inspections were coming incredibly, coming back incredibly late, that people were finding that they got two different two different judgements at the same time. It just felt it felt chaotic. And I think if if it feels chaotic, you don't have respect. But I think it's I think it goes deeper than that. I think that's the question you're asking me, I think, and I'm not there yet.
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Speaker 1
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Speaker 1
And you will decide whether I will be. But I think it's become quite demoralised as an organisation and I think demoralised organisations and I do have experience of those. I think demoralised organisations don't function terribly well and they don't have confidence, so that when they go and do an inspection, they don't have the confidence that they might have had if the organisation itself felt held together, felt held , actually. And I think that's fundamentally at the bottom of all the rest of it.
I think losing Julian Hartley very quickly after his appointment was a real problem for them. I think Mike Richards resignation was another problem. They felt unstable. They felt like they hadn't had the kind of leadership that would make them feel that they're respected by their leaders and their held, but they're also told when it's just not up to scratch. So I think that's that's at the bottom of a lot of it.
But the symptoms are delays, inadequate performance, feeling like a bit of a mess and a bit sad.
I think losing Julian Hartley very quickly after his appointment was a real problem for them. I think Mike Richards resignation was another problem. They felt unstable. They felt like they hadn't had the kind of leadership that would make them feel that they're respected by their leaders and their held, but they're also told when it's just not up to scratch. So I think that's that's at the bottom of a lot of it.
But the symptoms are delays, inadequate performance, feeling like a bit of a mess and a bit sad.
09:37
Layla Moran
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Layla Moran
And it's worth saying there will be many who are working in the CQC very interested in this hearing today. When we when we criticise it is not individuals who work below the executive team level that we are aiming at, but I think it is important that we have a fair and frank discussion about about the turnaround, because, I mean, would you agree this is a turnaround job?
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Speaker 1
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Speaker 1
Not of its size, but of need? Yes. So, yes, I can give you I can give you two examples. So I arrived at the King's Fund as chief executive, then not chair. This is a long time ago. This is 1997. But I arrived when they'd had they'd lost a lot of money and they had to reduce their size by half. And they had to look closely at what their purpose would be.
Now, the King's Fund is a small organisation, smaller now than it was then, but it was it did have to be a complete turnaround. And we did it and it got its confidence back and it I hope and think it did some remarkable things once it had got its confidence back. What
Now, the King's Fund is a small organisation, smaller now than it was then, but it was it did have to be a complete turnaround. And we did it and it got its confidence back and it I hope and think it did some remarkable things once it had got its confidence back. What
09:38
09:38
Speaker 1
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Speaker 1
The first thing you need to do is, is meet the people who work within the organisation and meet the people, if you like, who are the users of the organisation. So there's a huge amount of listening to do. And I know that Emily Miles, who is coming in as chief exec, also believes that the first thing we need to do is a huge amount of listening, and I think we need to give the people within the organisation and the people who use it or inspected by it, and the public, I mean, the public, after all, have to trust the CQC, have to give them the confidence that we're listening and that then we will take some actions.
Many of those actions actually have already been taken. I do want to say that Kay Boycott, as acting chair with her team, has done a remarkable job in actually quite difficult circumstances. After Mike had gone and after Julian had gone. So I do want to say that, you know, the performance is is significantly better than it was. And I'm told I haven't gone in. I'm told that staff morale is on the up.
Many of those actions actually have already been taken. I do want to say that Kay Boycott, as acting chair with her team, has done a remarkable job in actually quite difficult circumstances. After Mike had gone and after Julian had gone. So I do want to say that, you know, the performance is is significantly better than it was. And I'm told I haven't gone in. I'm told that staff morale is on the up.
09:39
09:39
Josh Fenton-Glynn
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Josh Fenton-Glynn
Thank you. So in your questionnaire to us, you said that you hope to help see CQC get back to a position of trust and respect. Now, I previously worked for another regulator before I came to this place, and I've been the head of a social care department. So I've also been regulated by CQC. I would say that trust and respect weren't the words that came to my head thinking of CQC. So what are we going to do to get that back?
09:40
Speaker 1
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Speaker 1
As I said before, a lot of a lot of listening, but also really thinking through and this is more the chief exec than me, but really thinking through how inspections are done, who carries out the inspections? Can we use more inspectors? But, you know, from different areas , using them across the country, doing something to make. Make people feel that it's fair? I have a daughter, by the way, who is a psychiatric social worker.
So she too is regulated by the CQC. So I think I think it's that I think people need to feel it. It's fair. And I think if they feel it's fair and that they meet the inspectors and they have some respect for them, I think you grow the respect.
So she too is regulated by the CQC. So I think I think it's that I think people need to feel it. It's fair. And I think if they feel it's fair and that they meet the inspectors and they have some respect for them, I think you grow the respect.
09:41
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09:41
Speaker 1
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Speaker 1
I think it's about the nature of the inspections. I mean, you've been inspected. I haven't yet been out on an inspection, but of course, that's one of the things I will do, you know, don't have to be there for the whole inspection, but be there to, to see it in progress. I've only been the other side.
09:42
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09:42
Speaker 1
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Speaker 1
So I wasn't directly in the room on the other side. And in fact UCL is being inspected at the moment and I'm recusing myself for obvious reasons. So which is actually a bit of a shame. I'd quite like to have been on the other side, but I don't think it's right. So. But from what I hear, it's mixed. So you have a combination of people, you know, saying that they had a very good discussion with inspectors and that it was a not a benign.
I don't think I would say it was a benign process, but it felt like a fair process. And the.
I don't think I would say it was a benign process, but it felt like a fair process. And the.
09:42
Speaker 1
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Speaker 1
A sort of yes. I mean, it was a collaborative trying to find things out. And then you get, you know, you get the report and you can send back things that you don't think are right and sort of all of that. And that feels quite positive. But equally, I have heard of them saying, you know, picking up on something very minor, but missing something very major, including and this applies to the internal stuff within the CQC, where the atmosphere in a particular department is quite tricky or even hostile.
09:43
Josh Fenton-Glynn
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Josh Fenton-Glynn
So I guess so. I mean, obviously any inspector will have trouble with those that they inspect because there's a lot of anxiety. Now, you'll have seen that the government have done quite a lot to to change the way that Ofsted works because of the detrimental impact it was having on headteachers and so forth. One thing they did was they moved away from the single word assessments of, of, of schools. Do you think it makes sense from a policy point of view that at the same time that Ofsted moved away from single word assessments because he didn't think it, it properly summarised what a department or a school was like that CQC moved in the opposite direction and brought in a single single assessment framework for local authorities.
09:44
Speaker 1
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Speaker 1
I don't think I can comment on that yet. However, I have to also declare that my son is a headteacher regulated by Ofsted. So? So yes, I hear quite a lot about Ofsted, but I think I would have to say I need to look at how it works before I can comment on that. I mean, why would you do that? In plain policy terms, it looks a bit odd, but I'd have to look at it.
I can't I can't comment on that yet.
I can't I can't comment on that yet.
09:44
Josh Fenton-Glynn
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Josh Fenton-Glynn
I mean, one thing that the dash review found was that there's kind of limited information available for providers and users, so they don't know what good care looks like under all the ratings in terms of your, I mean, obviously you've you've had so many roles around health and care. Do you can you say at this point, going in with confidence that you know, what good care looks like and what the different ratings would look like?
09:45
Speaker 1
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Speaker 1
I can't say I know with confidence what exactly they would look like. I think I know from experience of chairing health organisations, I think you can feel what a good institution feels like. Sometimes people say, I think I'd even share that view. And it's certainly true in social care. You can sometimes do it by smell. I know that sounds absurd, but it's true.
09:45
09:45
Speaker 1
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Speaker 1
Yeah. And you? There are various things. You get a sense. You get a sense by of the confidence of staff to speak out. Those are some of those things. Now that those are part of what good looks like. But I can't say this is good. This is requires improvement. I need to look at that in much greater detail with the new chief exec.
I think we will do some thinking about that. But the first thing I want to do is to actually restore some confidence. Do you
I think we will do some thinking about that. But the first thing I want to do is to actually restore some confidence. Do you
09:46
09:46
Speaker 1
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Speaker 1
I think the public find it easier to understand the single assessment ratings than actually people working in the service, because I think the closer you are to something, the more nuanced it always is. So I think the public doesn't have so much of a problem with, you know, good requires improvement, as probably we do.
09:46
09:46
Danny Beales
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Danny Beales
Thank you. We've talked about the kind of complexity of turning around the organisation, which has seemed in freefall. I've talked about the complexity, the the kind of length of time that might take. You mentioned the kind of conveyor belt of leadership which has been destabilizing. It all kind of points to the need for stability and long term effort. How long do you envision this task to take? How long do you envisage yourself to be in the role as chair? Is the length of time needed? Do you have that ability to commit to.
? I'm
? I'm
09:47
Speaker 1
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Speaker 1
old, so I won't clearly do it forever, nor do you expect me to. I think that we will know whether we're on the right track within a year, and I would commit to doing at least one term. I then will be really quite old, and I had always thought that I'd be out before I was 80, so that probably remains the case. But let's see, I mean, I, I think we will know within a year whether it's stabilized.
Its performance has really improved considerably, which it is already doing. So I think that's actually quite important. You
Its performance has really improved considerably, which it is already doing. So I think that's actually quite important. You
09:47
09:47
09:48
Speaker 1
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Speaker 1
I don't think it needs requires further change. I would rather hope it doesn't. But I think you can get a sense within an organization if it's going in the right direction. Usually within 12 months it might be 18, but it would be that kind of length of time. It takes a long time, I think, for staff to feel confident, really confident in leadership, and they need to feel confident in leadership to do their job better.
And that will help the confidence in the regulated community. And ultimately, I would hope, therefore increase public confidence. But I would have thought we would know the direction of travel within the year.
And that will help the confidence in the regulated community. And ultimately, I would hope, therefore increase public confidence. But I would have thought we would know the direction of travel within the year.
09:48
Danny Beales
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Danny Beales
I suppose. You know, I guess there's an old adage you need to give a football manager some time. You know, you might lose a few games initially. You might not be the best first season. You know, people in business, even in, you know, being an MP, it takes a year to get to know just the fundamentals of an organisation, the rules, the business, the compliance practices. Do you think it's realistic in a year to see the organisation change, bearing in mind the journey it's gone through and just the challenge again, is this not something that a leadership team and executive team needs to kind of have a good, significant number of years to turn around from where it is to not to avoid a single kind of word judgement to, to be a good organisation.
09:49
Speaker 1
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Speaker 1
I didn't say it would be a good organisation within a year, but I did say within a year you would be able to feel whether the direction of travel was going the right way. I don't know, I can't do the football analogy because I'm no good on the football stuff, and I still get lost in the House of Lords and I've been there over 20 years. So I absolutely accept that. You know, it, it takes ages.
But what I do think is when people start feeling better about the feel of an organisation, you can tell and you can actually then say, it's going to take us another two, three, four, five years to become the good or the excellent organisation. And you can talk to school leadership about that actually as well. But you do know quite quickly whether it's feeling better. And you can you can feel it in your fingertips before the performance indicators show you.
But what I do think is when people start feeling better about the feel of an organisation, you can tell and you can actually then say, it's going to take us another two, three, four, five years to become the good or the excellent organisation. And you can talk to school leadership about that actually as well. But you do know quite quickly whether it's feeling better. And you can you can feel it in your fingertips before the performance indicators show you.
09:50
Danny Beales
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Danny Beales
I guess just to finish, I'd agree with that, that that point, I suppose, holding the senior leadership team to account to deliver that journey of change over five years. Because my challenge to you is, are you committing to do that over that period of time from a board and governance perspective, sometimes having a constant change in board, chair and in the board can undermine holding the executive team to account, actually delivering?
09:50
Speaker 1
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Speaker 1
I completely agree, I will definitely do one term. I will be quite old, as I said. So I think the point is, you know, how much longer would they want with the old bat and how much longer would it be useful for me to do? But I will definitely do one term , and if it seems right, I would continue, let us say, for a year or two, but I, I don't I don't think it's right to be in a position where they want you to go, and I've actually been extended twice at UCL, so they've wanted me to stay.
I've got to go now and I do. I do agree with you that stability is good for an organisation. Stability of leadership is good for an organisation. So I would definitely give it three years. Whatever.
I've got to go now and I do. I do agree with you that stability is good for an organisation. Stability of leadership is good for an organisation. So I would definitely give it three years. Whatever.
09:51
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09:52
Layla Moran
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Layla Moran
09:52
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09:52
Layla Moran
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Layla Moran
understand and and did you know her from before. No, no you haven't, you haven't known her from before. Okay. What's your style of chairing very briefly. Are you a very involved chair. Are you a daily check in kind of chair or are you a sort of hands off? Come to me if you've got a problem, chair. What's your what's your style?
09:53
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09:53
Speaker 1
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Speaker 1
Okay, so I think I'm quite collaborative. I've always had in any organisation I've chaired all the other way round when I've been the chief exec and I've had a chair, I've always had a very good working relationship with the chair or the chief executive, if it happens to be. In some cases they have become my friends after I have no longer been in the position. I don't think you want to have a close friendship because it's a working relationship where you're, in fact, holding somebody to account.
I think I'm very collaborative. I like chairing organisations. I like the pulling a team of directors together. I like the feeling that you make decisions together, but then different members of the of the board actually carry them out or are responsible with ensuring that they are carried out. And I suppose what I am is, is I, I try and be a kind of supportive friend to the organisation as chair.
So in my time as chair of the two NHS trusts, I do a lot of walking around and meeting staff, and I think that that's quite valuable so that they feel that should they need to, they can come and talk to me and I have an open door.
I think I'm very collaborative. I like chairing organisations. I like the pulling a team of directors together. I like the feeling that you make decisions together, but then different members of the of the board actually carry them out or are responsible with ensuring that they are carried out. And I suppose what I am is, is I, I try and be a kind of supportive friend to the organisation as chair.
So in my time as chair of the two NHS trusts, I do a lot of walking around and meeting staff, and I think that that's quite valuable so that they feel that should they need to, they can come and talk to me and I have an open door.
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09:54
Speaker 1
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Speaker 1
It won't be half time at the beginning. I mean, it clearly won't be half time at the beginning apart from anything else, if you're going to go round and and meet people and talk to them and, you know, a lot of remote working. So a lot of it's going to be online. But if you're going to do that, it's clearly not going to be half time at the beginning. It will probably be quite a lot less as as it goes on, but it will not be half time at the beginning.
And I'm well aware of that and up for it, because I think because, as I said at the beginning, I think this really needs to be done. I really think we have to have a regulator that works and is respected. So I would expect to do three and a half, four days, certainly at the beginning, and I would expect to work very closely with the chief exec at the beginning and work out who's going to do what and how much we're doing together and how much we do separately and all of that.
So I think it will be a lot of time at the beginning, and I would say that Kay Boycott, who's been acting as chair, I'm sure she has been doing more than two and a half or three days a week.
And I'm well aware of that and up for it, because I think because, as I said at the beginning, I think this really needs to be done. I really think we have to have a regulator that works and is respected. So I would expect to do three and a half, four days, certainly at the beginning, and I would expect to work very closely with the chief exec at the beginning and work out who's going to do what and how much we're doing together and how much we do separately and all of that.
So I think it will be a lot of time at the beginning, and I would say that Kay Boycott, who's been acting as chair, I'm sure she has been doing more than two and a half or three days a week.
09:55
Joe Robertson
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Joe Robertson
09:56
Speaker 1
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Speaker 1
I don't think it. It presents a problem as such. I think I will learn, and I think you can learn that quite quickly. And the chief exec is a regulator, so I come, if you like, with the service experience and she comes with the regulatory experience. That should be quite a good match actually. Of course I'll learn. And my last sort of proper regulatory experience was in the GMC very many years ago.
And regulating doctors individually is very different from what the CQC does. However, having been within the service and knowing a fair bit about, you know, how I've also seen quite a lot of regulation within the care sector. Having seen it from the other end, I think it helps you to understand a bit of how it works. But but the the detail and the technicalities of regulation, I will simply have to learn.
But that should be all right.
And regulating doctors individually is very different from what the CQC does. However, having been within the service and knowing a fair bit about, you know, how I've also seen quite a lot of regulation within the care sector. Having seen it from the other end, I think it helps you to understand a bit of how it works. But but the the detail and the technicalities of regulation, I will simply have to learn.
But that should be all right.
09:57
09:57
Speaker 1
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Speaker 1
Well, there's the question about sort of some of the things that are absolutely needed by the CQC, like a really good IT system. I haven't talked to Emily about this, so I don't know what her expertise in it is. But, you know, my expertise in it isn't great. We need to have serious expertise in it on that board. And, you know, and we. And we need to make that a we need to make that something that we think about very hard.
And that's particularly true with AI and all the, all the things that are happening there. I think we need somebody on the board who's absolutely up to speed in all of that. And that's something I do feel that, you know, Emily and I and the board, as we have it now, doesn't have all the expertise that we would need.
And that's particularly true with AI and all the, all the things that are happening there. I think we need somebody on the board who's absolutely up to speed in all of that. And that's something I do feel that, you know, Emily and I and the board, as we have it now, doesn't have all the expertise that we would need.
09:58
Joe Robertson
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Joe Robertson
And finally, social care and the vital role that local authorities play, I think, is often treated as second class to NHS and health care across the whole sphere of policy making and frankly, spending. Do you see any issues that exist within the way the CQC operates that fails to elevate the importance given to social care and the way it's regulated?
09:58
Speaker 1
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Speaker 1
Oddly enough, I mean, and I'm not in I'm not inside the organisation yet. So so there's some things that I can't comment on. But most people that I've talked to externally find what happens. The inspection in the social care area actually more satisfactory than in the health area. So I think that that part of the work seems to have greater trust, although I think quite a lot of social care providers find it quite irritating.
I think there's quite a lot of respect there. I ought to, by the way, say that, you know, wearing a different hat, a private hat. I'm quite involved in some work to up the status of care workers within the social care sector. I'm a trustee of the Raine Foundation, and we're doing this thing called better, better career, better Careers for better care, which I'm deeply involved in. So I do see quite a lot of social care at the moment.
I will stop doing that in December. Anyway.
I think there's quite a lot of respect there. I ought to, by the way, say that, you know, wearing a different hat, a private hat. I'm quite involved in some work to up the status of care workers within the social care sector. I'm a trustee of the Raine Foundation, and we're doing this thing called better, better career, better Careers for better care, which I'm deeply involved in. So I do see quite a lot of social care at the moment.
I will stop doing that in December. Anyway.
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10:00
Speaker 1
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Speaker 1
So they were both pretty thorough looks. And of course, the Richards review was before he became chair. I want to also say that Michael Richards, Mike Richards is one of my closest friends, very, very old friend. We go back to student days. So what would I say? I think what you learn is that when an when an outsider who isn't a complete outsider looks at an organisation, they can. They can look at some things that people within the organisation don't seem to be able to see.
I think that's often the case, by the way. And I think that in both cases they've done some very useful things on detail. As I said before, I can't comment yet on the h-iib point, which I think is something that you very, very much take to heart. I mean, would I have started from here? No, I'm not sure that I, I think the recommendation of going into the CQC was something that I would necessarily have gone with, but that's where we are.
I think that's often the case, by the way. And I think that in both cases they've done some very useful things on detail. As I said before, I can't comment yet on the h-iib point, which I think is something that you very, very much take to heart. I mean, would I have started from here? No, I'm not sure that I, I think the recommendation of going into the CQC was something that I would necessarily have gone with, but that's where we are.
10:01
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Speaker 1
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Speaker 1
Yes, I think we will probably come to that. but I think we will probably come to that. But that comes out, of course, the dash review, which is one of the reasons that I raise it now. So I think that you you look at the review, you look at what you can learn from it. Did they spot things that the organisation itself can't spot? Well, yes, almost certainly so. And what do you do with it and on.
He said I'm very happy to talk further about that.
He said I'm very happy to talk further about that.
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Speaker 1
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Speaker 1
From the reviews, I think from the sense of the I much more from what I've learned from being in, in, in two health organisations actually, and from and from talking to people in care organisations, which I've been doing quite a lot because of the Rain Foundation work, I think it's a much more from the people that have experienced inspection and also actually from just the public publicity generally about the CQC and inspection and standards .
And
And
10:02
Danny Beales
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Danny Beales
I know we're going to come to that issue in a bit, but there has been kind of widening of scope of the role of CQC and at the same time, existing challenges of delivering the responsibilities that it has. Do you have a sense of where the balance and priority should be on? I guess doing new things better or focusing on the fundamentals of the existing responsibilities and backlogs?
10:02
Speaker 1
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Speaker 1
Of course you have to do that. You have to. You have to get the basics right before you can take on the new, in my view, and I know that Wes Streeting, when he was secretary of state, said that that the CQC wouldn't be taking on Seb until until it was, if you like. Ready? I agree, I think that's right. I think the point I think there's a difficult point in judging.
I think that's the point that that you've made. I think there's a difficult point in judging when that time is right. But as I said before, I think you can tell about the sense of direction within a year. I think if assuming that the legislation goes through, assuming the decision remains that Seb goes into seat the CQC, we would make it work. But I would hope that the CQC would be given enough time under my leadership and Emily's leadership to stabilise the ship and to get those basics as you describe them right and and begin to get the respect back.
I mean, I'm thinking about I'm thinking about the early days of the CQC. I'm thinking about when Mike Richards was chief Inspector of hospitals. The CQC was very much respected. It was somewhat feared, but it was very much respected and I want to get that back.
I think that's the point that that you've made. I think there's a difficult point in judging when that time is right. But as I said before, I think you can tell about the sense of direction within a year. I think if assuming that the legislation goes through, assuming the decision remains that Seb goes into seat the CQC, we would make it work. But I would hope that the CQC would be given enough time under my leadership and Emily's leadership to stabilise the ship and to get those basics as you describe them right and and begin to get the respect back.
I mean, I'm thinking about I'm thinking about the early days of the CQC. I'm thinking about when Mike Richards was chief Inspector of hospitals. The CQC was very much respected. It was somewhat feared, but it was very much respected and I want to get that back.
10:04
10:04
Speaker 1
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Speaker 1
I think so, I'm not inside and I have very deliberately not been inside until you confirm me or otherwise, but I do. I think that it can be turned around. Yes. And I think the evidence is that it is its performance is getting better. I think Kay has provided that leadership. And Aaron, I think the team have provided that leadership and we can see performance improving. So do I think it is possible? Almost certainly, yes.
I'll be able to tell you a bit more when I'm there, but I do. I think it's possible, yes. I think it's going to be quite a big job though.
I'll be able to tell you a bit more when I'm there, but I do. I think it's possible, yes. I think it's going to be quite a big job though.
10:05
Danny Beales
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Danny Beales
As as well as. Providing assurance about the quality of care, there are unfortunately instances we've seen them far too frequently, unfortunately, of quite serious failure of providers of different sorts, the committees looking at them at Saint Andrew's around mental health. I think we're going to come to maternity later. There'll be more questions specifically about that. Does it worry you that in all those instances, CQC has actually been there at different points? Yes.
People have been harmed. There's been serious failure. Of course. Do. What do you think is Cqc's role in in acting? How quickly it should act? Should, should. Should there be more quick intervention from the regulatory, you know, state when concerns like this are evident, it feels, you know, in a number of instances that it's many, many, many years before for national inquiries are eventually called.
But the regulators, the, the people that should be assuring people of safety, you know, have been there often right from the start.
People have been harmed. There's been serious failure. Of course. Do. What do you think is Cqc's role in in acting? How quickly it should act? Should, should. Should there be more quick intervention from the regulatory, you know, state when concerns like this are evident, it feels, you know, in a number of instances that it's many, many, many years before for national inquiries are eventually called.
But the regulators, the, the people that should be assuring people of safety, you know, have been there often right from the start.
10:06
Speaker 1
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Speaker 1
I think that that I mean, I, I don't. I agree with you. I think what I'm saying, I would expect a regulator to flag stuff up. You're not always going to be able to do it. Regulators aren't always going to see where there are problems. Obviously not. And very often you would need an inquiry in a particular for a particular thing. But I would expect if the regulator has found things that are of serious concern, I would expect that to be flagged quite quickly.
Yes.
Yes.
10:06
Danny Beales
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Danny Beales
You talked about you know, you're seeing you believe there's signs of improvement, kind of turning to culture specifically, I think recent surveys have indicated a decline in kind of staff confidence that might not fully, you know, time periods and lagging might not fully reflect more recent leadership changes. But, you know, it identified kind of concern about being supported by leaders not being listened enough. You talked a lot about listening being a priority and concerns not being acted on.
What's your view of the organisational culture and staff morale?
What's your view of the organisational culture and staff morale?
10:07
Speaker 1
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Speaker 1
So I'm not there yet, but from what I hear, it's been quite low. I suspect that the staff survey is a bit of a there's a bit of a lag, probably, but that's one of the first things I would want to address with Emily. I think you need to have staff morale up to get the confidence back. Absolutely essential.
10:08
Speaker 1
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Speaker 1
I mean, I think the first action is simply to get to know people, actually, and I know that sounds ridiculous, but I think it's true. I think just I mean, I one of the things that I've done a lot of in my time chairing both NHS organisations is, is said, you know, gone to see people at work and also said, thank you a lot. I think some of those things are quite basic, and I suspect we need to do quite a lot of that.
10:08
10:08
Speaker 1
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Speaker 1
think they I think they probably were, but it all felt chaotic. And then Julian left very quickly. Don't forget Julian. Julian Hartley instituted quite a lot of changes, brought a lot of people in and then left very suddenly. And that that's really hard for an organisation. And they feel kind of they don't feel held anymore. So I think that's. So I think that coming. And I think the fact that Emily and I will come in at roughly the same time, I'm a couple of weeks earlier than her.
I think that's quite helpful. That were both will both be there and both be listening. I mean, we'll probably listen in different ways and speak to different people, but we'll both be there. And I think that is quite important.
I think that's quite helpful. That were both will both be there and both be listening. I mean, we'll probably listen in different ways and speak to different people, but we'll both be there. And I think that is quite important.
10:09
10:09
Speaker 1
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Speaker 1
Well, as I said before, I think you can feel quite a lot of it. But of course the staff survey. So you the staff survey will lag, but the staff survey. So at UCL we always do incredibly well in the staff survey. And I think that tells you something about the culture of the organisation, and I think that's really important. And I, I do I do believe that organisations function well when the staff feel supported and they feel you're fair.
I mean, sometimes you're not, you know, you're not necessarily going to agree with them. Sometimes you're going to think that some people aren't doing a particularly good job, but you're going to be fair.
I mean, sometimes you're not, you know, you're not necessarily going to agree with them. Sometimes you're going to think that some people aren't doing a particularly good job, but you're going to be fair.
10:10
10:10
Andrew George
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Andrew George
Thank you. Well, in answer to that last question, you referred back again to your emphasis on, on, on, on feeling. You feel matters and you can smell whether an organisation is up to scratch or not. I mean, is there is there not a risk that unless you have some kind of objective means of measuring that you fall into kind of mores and kind of metropolitan club ability of, of, of people that you meet.
You talk about your friendship with Mike Richards. There is, there is a kind of a risk, isn't there, that that you're, you're working within the, a bubble of, of, of smell and feel and not perhaps sufficiently self-reflective of, of being able to see what's really going on is.
You talk about your friendship with Mike Richards. There is, there is a kind of a risk, isn't there, that that you're, you're working within the, a bubble of, of, of smell and feel and not perhaps sufficiently self-reflective of, of being able to see what's really going on is.
10:10
Speaker 1
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Speaker 1
No, I don't think I'm saying that I think you need the rigour of metrics and I think you need. So I think that the staff survey is one way of getting a metric on, on how the staff are feeling. But as I said, there's a lag, so you can usually pick up a change before you can see it in the metrics equally with a hospital or with a care home.
The inspection inspects against standards which are objective. And you can you can tell the direction of travel from that. But again, I think you can get the feel of it usually before you get the metric. That's all I'm saying. And the metropolitan bubble, I think it's probably fair to say that although Mike Richards is one of my closest friends, I don't think that he thought it was a great idea to become chair of the CQC.
I'm not sure it was a wholly happy experience for him. And, you know, I think I'm doing it because I think it needs to be done. Really.
The inspection inspects against standards which are objective. And you can you can tell the direction of travel from that. But again, I think you can get the feel of it usually before you get the metric. That's all I'm saying. And the metropolitan bubble, I think it's probably fair to say that although Mike Richards is one of my closest friends, I don't think that he thought it was a great idea to become chair of the CQC.
I'm not sure it was a wholly happy experience for him. And, you know, I think I'm doing it because I think it needs to be done. Really.
10:12
Andrew George
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Andrew George
Can I offer a another smell or feel which is on the ground where where I live and operate in West Cornwall, which is where people don't feel confident in the CQC that it's doing its job, that it's undertaking sufficient inspections. And the the impression is that certainly if people are going looking for a suitable care home for their loved one, they have no confidence that the CQC is has provided them with with satisfactory, you know, information.
So. So the smell and feel out there is not a good one, whereas you're getting the impression that that the smell and feel is is coming around.
So. So the smell and feel out there is not a good one, whereas you're getting the impression that that the smell and feel is is coming around.
10:12
Speaker 1
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Speaker 1
No, not yet, but I am getting the impression and that may be wrong. I am getting the impression that there is less dissatisfaction with the inspection regime on the social care side than there is in the health side. That's all I'm saying. I think if there's dissatisfaction with how the CQC inspects care homes, that is something we should take extremely seriously. And assuming I am imposed along with Emily and the people in charge of inspection of social care, I will look at that.
I don't think I would take I don't think I would take anything for granted.
I don't think I would take I don't think I would take anything for granted.
10:13
Andrew George
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Andrew George
Thank you. And and with regard to to Emily and I'm aware that Emily is is present. There has been some observation, at least that that that Emily doesn't come from a health and social care background. I think currently within a different role. I mean, how confident are you that it is appropriate to have a chief executive without without that background experience? And do you think that she can she can realistically get up to speed in terms of the, the, the nature and complexity of the of the sector in which she'll be asked to, to operate?
10:14
Speaker 1
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Speaker 1
Yes, I think she can. I think she's a regulator, which I think we absolutely need. And with experience of that, and I come with the health and social care experience. But also we have a board with health and social care experience, actually , a board that doesn't have enough regulatory experience, in my view. But we have a board with quite a lot of health and social care inspection expertise and specific individuals who are the leaders for the particular areas of inspection who are experts themselves.
So I think that's fine myself.
So I think that's fine myself.
10:14
Andrew George
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Andrew George
Okay, just moving back to the subject, which which you, you raised yourself, which, which is, which is and the appropriateness of bringing an investigatory body into a regulatory body that that merger has been subject to significant comment and criticism, as you know, how confident are you looking at it as someone coming in, as it were from the outside, that that an organization like SIB, admittedly, it's relatively young, but it has a good reputation and is much admired by by people within the sector as a as very much a harbor to which they can report matters of concern.
How satisfied are you that it's actually a wise move to to take that risk?
How satisfied are you that it's actually a wise move to to take that risk?
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10:16
Speaker 1
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Speaker 1
Yes, but but let me say that assuming that it goes ahead, which I think to be honest, is probably likely. We would have to make it work. That means Chinese walls, and that means making sure that the QC is itself in a better place than it is now, before it happens. And I think that's what all I can say. I mean, it does seem to me that there are different kinds of bodies.
And I , in that sense, would I necessarily have done it? No. But that's the government decision. And the QC, if that is what happens, will make it work. But I think we would want some time before that even happened.
And I , in that sense, would I necessarily have done it? No. But that's the government decision. And the QC, if that is what happens, will make it work. But I think we would want some time before that even happened.
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10:17
Andrew George
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Andrew George
Yes, of course we are in public. Absolutely. But but the the point the point is, do you not think that it's appropriate that coming in, that you should be able to express your view very bluntly to to. the to the new Secretary of State that where you you feel uncomfortable that such a merger about such a merger that that actually that view should , should pertain as well. Even during the passage of the health bill.
10:17
10:17
Andrew George
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Andrew George
Okay. Well, that's very helpful. I mean, in terms in terms of I mean, you talk about Chinese walls, but there's also the risk of Chinese whispers as well, isn't there? And the problem that I think a lot of those in the sector are worried about is that, is that the that H. SIB provides a safe space for clinicians to raise concerns without fear of it getting into complex litigation. And that seems to be a very attractive option, I would have thought, and one that would advance patient safety.
And I and I, I cannot believe that that that those within the CQC would be prepared to take the risk of, of going into a world where there's a lot of uncertainty, whether it's going to work through the merger.
And I and I, I cannot believe that that that those within the CQC would be prepared to take the risk of, of going into a world where there's a lot of uncertainty, whether it's going to work through the merger.
10:18
Speaker 1
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Speaker 1
Well, I think that to some extent they may have to. So let's see where that goes. I'm very happy to come back and I'm assuming I'm do this. I'm very happy to come back when we know exactly how it's going to work. But I think. I mean, I think I agree with you, it's the safe space bit that bothers me and how you keep that completely separate. And I think we would make it work.
But exactly how at this stage, and I'm an outsider still exactly how I simply can't say. But that's something that I think Emily and I will want to talk about very quickly and with Kay.
But exactly how at this stage, and I'm an outsider still exactly how I simply can't say. But that's something that I think Emily and I will want to talk about very quickly and with Kay.
10:19
10:19
10:19
Jen Craft
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Jen Craft
Thank you. Chair, I'd just like to turn to maternity services. And you'll be aware that in Baroness Amos review, and indeed, she came and spoke to this committee, and she told us that during her review of maternity services, she found significant regional variation in the way that the CQC operates and picked up that quite often there was insufficient expertise to adequately inspect maternity services. How will you take steps, and what steps will you take to make sure that the organisation is able, and has the right expertise in place to regulate these vital services? And I think, quite crucially, how will you make sure that the public has confidence in the CQC s ability to do so?
10:19
Speaker 1
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Speaker 1
Well, let me say that what's been going on with with maternity is one of the reasons that convinced me, in the end to say yes, because I'm so worried about it, deeply concerned about what Baroness Amos has said, what Donna Ockenden has said and what we're hearing. So I think very early on with Emily and with the team, I want to sit down and look at that in in great detail. I mean, I think I suspect, but I may not be right.
I suspect that if you looked at other areas of practice, you would also find situations where there wasn't adequate expertise always amongst the inspectors. And I think that is something that we need to look at very closely and work out how we make sure that there's adequate expertise and that the the sector, the group being regulated, you know, the maternity department, wherever they happen to be being regulated, feels that it's being done fairly. And because the other thing that's happening at the moment, and I speak at the moment as chair of two providers, is, of course, maternity departments themselves are now incredibly worried and scared and all over the place, and midwives particularly, and it's becoming increasingly difficult to recruit midwives.
So it's it's a huge issue. And I think that we have to look at how maternity is regulated, but actually we have to look at how everything is regulated and look at the expertise. And then I think, make sure that those who are being regulated feel that it's that awful phrase, firm but fair. And then I think the public will begin to have it get its confidence back. But we will look at it very quickly.
I suspect that if you looked at other areas of practice, you would also find situations where there wasn't adequate expertise always amongst the inspectors. And I think that is something that we need to look at very closely and work out how we make sure that there's adequate expertise and that the the sector, the group being regulated, you know, the maternity department, wherever they happen to be being regulated, feels that it's being done fairly. And because the other thing that's happening at the moment, and I speak at the moment as chair of two providers, is, of course, maternity departments themselves are now incredibly worried and scared and all over the place, and midwives particularly, and it's becoming increasingly difficult to recruit midwives.
So it's it's a huge issue. And I think that we have to look at how maternity is regulated, but actually we have to look at how everything is regulated and look at the expertise. And then I think, make sure that those who are being regulated feel that it's that awful phrase, firm but fair. And then I think the public will begin to have it get its confidence back. But we will look at it very quickly.
10:21
Jen Craft
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Jen Craft
Do you and I know you're still an outsider. Do you think there's a potentially a cultural issue amongst the way that inspection inspections are carried out? Do you think inspectors have the right frame of mind as to why they're there and what they're doing? And I just I think I'll flag the idea of in adult social care, you can have care agencies that can be given a rating by the CQC and inspected without anyone actually ever visiting any of the sites in which they operate.
Is, is is that something, do you think there's I I'm confused as to how you'd be able to visit a nondescript office, like carry out whatever inspections are to hand and say this care agency is good, or even more so? Do you think there's something in the way that those inspections are carried out? Do you think the inspectors themselves have the right attitude, if you like, and understand what they're there to do and why they're there to do it.
I
Is, is is that something, do you think there's I I'm confused as to how you'd be able to visit a nondescript office, like carry out whatever inspections are to hand and say this care agency is good, or even more so? Do you think there's something in the way that those inspections are carried out? Do you think the inspectors themselves have the right attitude, if you like, and understand what they're there to do and why they're there to do it.
I
10:22
Speaker 1
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Speaker 1
suspect, I mean, I'm not there, as you rightly said, I'm not there. I suspect people wouldn't be inspectors unless they had the right attitude. And, and the, the, the right sort of, if you like, underpinning of desire to make sure it's working well and indeed to some extent to make sure it improves. But I do think there is something that worries me considerably. And that's the extent to which the the user voice is heard.
And I think that's a much more general point. It's a more general point than actually about the CQC. I actually started in all of this as chair of the Patients Association a million years ago. I don't think the CQC is good enough at listening to the user voice. So in maternity and the sort of thing that you might expect is, you know, scanning, I don't know, it's Mumsnet or something like that. I mean that you would expect more of a, of a scanning of, of what's going on outside, I think to inform the culture of inspection.
That's one thing. And the other thing is I think that there's a, a general lack of, of user voice or in fact, in terms of social care, often it's family and carer voice. And I think that's something that needs to be looked at.
And I think that's a much more general point. It's a more general point than actually about the CQC. I actually started in all of this as chair of the Patients Association a million years ago. I don't think the CQC is good enough at listening to the user voice. So in maternity and the sort of thing that you might expect is, you know, scanning, I don't know, it's Mumsnet or something like that. I mean that you would expect more of a, of a scanning of, of what's going on outside, I think to inform the culture of inspection.
That's one thing. And the other thing is I think that there's a, a general lack of, of user voice or in fact, in terms of social care, often it's family and carer voice. And I think that's something that needs to be looked at.
10:23
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10:24
Layla Moran
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Layla Moran
For context. That came from my trust. So Oxford University Hospital's maternity unit, which became part of the Amos review because there were a large number of failures and vocal groups who weren't who, by the way, had written to the CQC over a number of years with their personal stories. And nothing happened to the personal story, which.
10:24
10:24
10:24
Jen Craft
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Jen Craft
Just to sort of dig into that a little bit in terms of putting user voice front and central, is that something that and how would you look to do it? How would you look to basically make everyone that works for the CQC aware of that has to be part of their focus, as well as everything else that they're looking at. That has to be part of their focus, as well as everything else that they're looking at. I think that's part of the culture change, and I think that's part of, you know, the leadership that that I would hope .
That I and
That I and
10:25
Layla Moran
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Layla Moran
10:25
10:25
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10:25
Layla Moran
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Layla Moran
Was saying it's not safe to have your baby there. It's not safe to have your baby there. I had to beg, by all means possible for them to come to Reinspect and now it is good again. But the parents will point out that actually there are still some concerns under the space of safety. So I would urge you to look at that. But I know that that is also reflected in other areas too, where too often the CQC is too late.
It's you know, the trusts have already identified problems. In fact, NHS England quite often comes in to sort it out. And then a year later the CQC comes to inspect. So, I mean, how do you . Intend to
It's you know, the trusts have already identified problems. In fact, NHS England quite often comes in to sort it out. And then a year later the CQC comes to inspect. So, I mean, how do you . Intend to
10:26
Jen Craft
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Jen Craft
sort out those sorts of issues? I mean, do you recognise what I'm absolutely recognise what you're saying. Look, I come from the provider side. Absolutely recognise what you're saying. Of course. But I think that the, the detail of how we try and sort that out is not for me to comment on yet. That's something that . Emily
10:26
10:26
10:26
Layla Moran
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Layla Moran
Do you know Penny? Have you worked with her before? I know her very slightly, very slightly. And in this broader landscape. I mean, where do you see the role of the CQC? You know, you read the review, but you are the chair of a provider. What role can this could CQC play now, but also in a future where it's up and running properly in that . Safety
10:27
10:27
10:27
Jen Craft
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Jen Craft
The quality board. And beyond that. There is proper. inspection that issues that are flagged are dealt with, that the public is listened to and its. concerns are acted upon, and that it. ultimately has the. confidence of both the the broader sector. And that's using health and social care and the public. And it's if you like, it's to some extent it would be the private provider arm of quality.
assurance for the quality board. That is how I would assume that it would work at best. It's going to take quite a while . To get
assurance for the quality board. That is how I would assume that it would work at best. It's going to take quite a while . To get
10:28
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10:28
Layla Moran
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Layla Moran
about? Not that I can think of. Fair enough. Otherwise I'd have put them down. That's what we assumed. But it's worth asking just in case. There was another that emerged in between. And then my very final question is, let's say we did have you back in a year. You've mentioned a year a number of times. As you know, in a year's time we will be seeing significant progress and so on.
So let's let's fast forward and I appreciate you're not there, but but play with me. Okay. In a year's time, and if we were to have a session like this again, maybe also with Emily, what sorts of. metrics should we be looking at to start to see that success? What would you hope to be able to bring to us as a committee? To show that direction of travel is not just starting, but starting to to .
Take hold in the
So let's let's fast forward and I appreciate you're not there, but but play with me. Okay. In a year's time, and if we were to have a session like this again, maybe also with Emily, what sorts of. metrics should we be looking at to start to see that success? What would you hope to be able to bring to us as a committee? To show that direction of travel is not just starting, but starting to to .
Take hold in the
10:29
Jen Craft
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Jen Craft
organisation. So I would hope that you would see the improved performance that you're already seeing vastly increased. I would hope that you would see a staff survey that is. considerably improved, although given the lag, that may be more difficult, I would hope that you would hear less concern from the public, although again, there will be a lag in that and I hope you would hear from provider.
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