Thursday, 20 June 2013

CQC, the bargain basement counting warehouse

I have mentioned before, rather too often for my own comfort, that the coalition missed a political trick by failing to articulate the absolute failure of New Labour's regime to control and manage public services.

Yes, they talked about the failures of central targets, but that was all. They did not join the dots and explain the core of the muddle they had inherited, as they could have done - perhaps because they had not quite grasped it themselves. Perhaps also because they were still half in the same mindset.

A few months into the new government in 2010, I asked a senior civil servant at the Department of Communities how they could square abolishing targets with embracing payment-by-results (really just targets with money attached) and just got blank faces.

I was reminded of this by the story about the goings-on at the Care Quality Commission (CQC), because I can't do better than the analysis by the influential NHS blogger Roy Lilley this morning:

"It is not honest to say central regulation works. It self evidently doesn't."

So, the real issue for me is not what should happen to the CQC managers who shredded a damning report, but why these catastrophic failures happen in the regulatory control regime the coalition inherited so innocently from New Labour, and which they haven't seen clearly enough to unravel.

Because New Labour was infected beyond any other government with the utilitarian fantasy that regulation was a matter of counting things.  It assumed that every public service was simply a version of an assembly line and could be tackled by standardising responses, and tuning the people involved into regulated machines.

So every time the system tightened up, the chances of the brilliant human beings in the front line to make things happen were that much more constrained. It has been a tragic tale of reduced effectiveness bought in the name of efficiency – and it isn’t over yet.

There was even a room at the Department for Education where you could stand surrounded by the data that poured in from schools around the country, and feel yourself at the controls of a giant education machine.

Nowhere in government was the fantasy of control as strong as it was there, as civil servants and ministers could sit there and feel they were looking at the dashboard of UK education. It was only when you got into real classrooms that the depth of this fantasy was obvious.

A friend of mine was a teaching assistant whose teacher, also an Ofsted inspector, spent much of the week in the stationery cupboard because she could no longer cope with the class. Yet the school was moving up the league tables.

The truth is that Frederick Taylor and Henry Ford's systems, applied to regulation in the UK, only seemed to increase efficiency.  It was a fantasy cheered on by the huge compliance industry, that helps companies measure their way to compliance with international legislation, but which fosters a peculiar obsession with figures at the expense of what is actually happening.  As the systems thinker John Seddon says, targets make organisations less effective and more expensive.

It was a fantasy of management like a giant machine, checking that the processes were followed, and believing the numbers that emerged.  This was what was responsible for the care failures being debated today, which led to the controversial shreded report.

CQC is a staggeringly dysfunctional organisation, a bargain basement counting warehouse, without insight or intuition, far too big to do more than count the numbers that pour in by fax (and yes, until recently, most of their care home returns were organised by fax).

It was designed by a government which believed that service regulation was all about minding the vast humming machine.  Its predictable failure should not mean that we all scurry about working out how to replace one kind of dysfunctional central control with another - but work out how we can hold services to account better locally.

You can find out what this means in practice in my book The Human Element.  But it is going to mean more people, more judgement and a great deal less counting.  But it will also mean a different style of control inside those services so that they might begin to claw back the effectiveness they lost during those utilitarian years of fantasy.


Anonymous said...

"But it is going to mean more people, more judgement and a great deal less counting. But it will also mean a different style of control inside those services so that they might begin to claw back the effectiveness they lost during those utilitarian years of fantasy."

Measuring Model T Ford production was easy - they were all the same and could be made in the same way.

When there is so much variety of needs and practices within education, health and care systems it is very difficult to identify key factors which could be measured to give a realistic idea of overall performance.

So the easy things are measured - e.g. how many incoming phone calls are answered within 3 rings instead of how many problems are actually solved at the first time of asking.

Richard Thomas said...

Generalising from the particular, is there a regulator that works effectively in the public interest? It seems evident to me that pretty well all of them, when they are not actually perniciously managed, as was the CQC, are ineffective in protecting the consumer and the public in general from the industries they are supposed to supervise. As an example, it took some unguarded words from the Prime Minister to stimulate Ofgem to move to give customers some protection from the monopolistic, even semi criminal behaviour of the energy companies.

The question is why this happens and the interview of one of CQC's team pointed at the Health Service in the particular case. I suspect that this is a general underlying fault with UK regulation - that the Civil service appoint the regulators and define their functions. The prime directive of all is not to rock the boat.