Australia can take some lessons from England’s experience as it moves towards the establishment of a quality commission for aged care, an industry conference has heard.
Sir David Behan headed England’s Care Quality Commission from 2012 to July this year after a series of crises in the nation’s aged and disability care sectors sparked a wave of national reform.
Speaking to Community Care Review from the ACSA Summit in Sydney on Tuesday, Sir David said there were “powerful resemblances” between what happened in the UK and the current situation in Australia, where a review of serious failures at South Australia’s Oakden facility led to recommendations for the establishment of a similar regulatory body.
Minister for Senior Australians and Aged Care Ken Wyatt announced in April that an independent regulator, the Aged Care Quality and Safety Commission, will from next year be responsible for approval, accreditation, assessment, monitoring, compliance and complaints management of all government subsidised aged care providers.
Sir David Behan: “If I look at the history of regulation in England, it’s driven by crises and scandals, and when I read the report of Oaken there were powerful, powerful resemblances with what had gone on in some of those stories in England.
“I think what Oaken has provided you with is an opportunity to fix some of the weaknesses in the system. The opportunity is to learn from what we’ve done in England and I hope that some of those things can inform your solutions here.”
England’s quality commission, consisting of 3,000 staff, regulates all care in England and providers must be registered to deliver service. Last year it carried out 49,000 investigations.
A series of landmark scandals
Prior to the 1970s, health in England was unregulated and private care was regulated by local authorities. The move to regulation was driven largely by a series of landmark scandals.
These included the Longcare inquiry into the serious abuse of people with learning difficulties, revelations of serious neglect of elderly people at Mid Staffordshire Hospital and the Winterbourne View care home scandal.
All of these failures reflected failures of governance, Sir David said.
Since then the CQC had introduced a range of reforms, including changing the way inspections are carried out and raising the bar for registration, as well as ushering in better ways of assessing and predicting risk.
Most importantly, the public had to be confident that the regulator had their interests at heart and was neither a mouthpiece for government nor a captive of providers.
“One of the key things I learnt is the importance of having an independent regulator, a regulator that’s independent of government and independent of providers and the language I would have used in England is being on the side of people that use services,” he said.
“I always conceptualise my role as holding three constituencies – the people who use services the public, the providers and politicians.
“My responsibilities was to all three but preserving independence, speaking truth to power at times about the effectiveness of the service, was a key responsibility. You need to be independent from sector and government.”
Hard and soft levers
The purpose of the commission was to make sure providers provided safe, effective and quality care and to encourage services to improve, he said.
This ranged from using “soft levers”, like providing information, building relationships and reviewing systems, to “hard levers” like prosecution and deregistration.
“In 2014 we were given the power to take criminal prosecutions against services … and we’ve increasingly used those powers. But our ultimate sanction is not to issue a fine, it’s to remove a registration and we’ve also used that power.”
But the strongest tool was the CQC’s power to regulate, which encouraged change to come from within, rather than being externally enforced.
“Regulation plays a really important role in setting out quality standards services should work towards.
“But it doesn’t replace the responsibility of providers to provide quality services. You cannot regulate quality into services because providers put quality into services by what they do and how they do it.
“What regulation can do is assess whether there is quality in services or not, report on that and then go back and check whether improvements have taken place.
“We rate services and this has a real currency. Hospitals, general practices, care homes want an outstanding rating because they want that badge that says they provide the really great care in England. Similarly there have been services which have been rated inadequately who if they haven’t been able to improve, their registration has been removed and they no longer provide care. So the bottom end of the market, who are providers who have left the market and at the top end services have continued to improve.”
Australia’s new commission will begin operations from January 1 next year.