Are managers finally set to become more accountable?

Directors in charge of care homes and hospitals that allow neglect and abuse to take place could be held personally and criminally accountable for failures in care, under proposals unveiled by Care and Support Minister Norman Lamb.

Plans include moves to introduce a fit and proper test for directors, as part of work to address problems in the current system that fail to hold company directors to account for serious failures in care.

The consultation forms part of the work to begin rebuilding trust in the health and care system, shaken by serious failures in care due to scandals like Winterbourne View and Mid-Staffs.

Some of the key proposals to ensure that directors of organisations are personally held to account include:

– The introduction of a compulsory ‘fit and proper’ person test for directors, resulting in removal from their post upon failing the test;

– Addressing the loophole in the system where providers responsible for appalling failures in care can escape prosecution; and

– Making it easier for the Care Quality Commission (CQC) to prosecute providers and their directors where there are clear failures to meet very basic standards of care. Remarkably, there have been no prosecutions for failures in care since the CQC was established.

Under the new proposals, organisations and their directors that fail to meet the new fundamental standards of care could face immediate action from the regulator including prosecution. CQC’s powers to prosecute for criminal neglect would be strengthened.

Currently, providers responsible for appalling care can escape prosecution, even in the worst cases. This is because CQC can only prosecute in cases where it has previously issued a warning notice to the provider and the provider has failed to comply with that warning notice. With the introduction of fundamental standards following the Francis Inquiry, we want to make it easier for CQC to prosecute providers where there are clear failures to meet basic standards of care, without the need to issue a warning notice first.

Norman Lamb, Care and Support Minister said: “Scandals like Winterbourne View and Mid-Staffs have damaged confidence in our health and care system. Part of our commitment to rebuilding that trust comes from making sure that people at all levels are held to account for failings when they occur.

“Whilst there must be a sharper focus on corporate accountability, more needs to be done to ensure those responsible for leading a care organisation are up to the job. I hope that providers and people who use services and their families will respond to this consultation as we look to take these proposals forward.

“The introduction of a mandatory ‘fit and proper person’ test for all directors within NHS trusts and foundation trusts, independent healthcare organisations and social care organisations regulated by the CQC, would determine whether they are suitable to fulfil their role. Conducted as background checks undertaken by the service provider, the tests would identify concerns about an individual’s honesty, integrity, competence and capability and include considering their past record with other providers. In cases where a director was deemed by the CQC to be unfit, the CQC could insist upon the director’s removal.”

These proposals are part of a wider package of changes to how CQC regulates health and social care providers. The CQC is now consulting on a new specialist model to improve hospital, social care and GP inspections, which includes setting new fundamental standards of care, and publishing ratings so that patients are clear about how their hospitals, care homes or home care providers are performing on leadership, finance and, most importantly, the quality of care.

Welcoming the consultation, CQC chief executive David Behan said: “Those who run health and care service are accountable for the quality and safety of the care they provide. People have a right to expect that care homes and hospitals meet basic standards of care. The power to prosecute, along with a ‘fit and proper’ person test for directors, gives people who use services greater assurance that poor care will be challenged and that they will receive safe and effective care.”

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