Second line is frontline workers
Third the exec and board
Fourth we must remember commissioners , by focussing on outcomes and the important impact of leadership and culture in achieving these commissioners fundamentally impact on quality.
Regulation comes a (?distant) 5th in that it has an intermittent and often reactive impact.
Day to day it is working with and listening close to patients (and carers) and frontline staff that we can drive continuous improvements in quality.
I totally agree with Jonathan Fielden's comments and welcome the expert academic focus on CQC inspection on organisation culture in hospitals but I need to stress that for too long the LD / ASD services have been ignored and people are dying and harmed needlessly, it is currently in a very dangerous place.
The organisation behaviour of NHS providers & so-called "too large to fail" types have become complacent and powerful because processes such as Complaints procedures, Safe-Guarding, have no "teeth" or sanctions without which you will not be able to change behaviour.
Similarly, the excellent "recommendations and guidelines" in the recently published "NICE Guidelines on Autism" will need to be changed from weasel words like Recommendations to Requirements and appropriate sanctions applied to those who have the responsibility and therefore should be accountable when serious incidents leading to harm and death to persons occur. Those persons directly responsible as well as the organisation culture that encourages should become liable under civil & criminal law.
Presently, these changes are moving too slowly to save and help many adults, children and families in distress and jeopardy.
2 weeks to go CQC confirm your inspection and request information such as your statement of purpose and information on complaints, or serious or adverse incidents?
My concerns are the majority of CCG Board members are GPs NOT Managers, they are ill equipped in their understanding of current LAWS and Legislation surrounding Section 117 of the 1983 MHA MCA or indeed the Care Act.
My meeting with a GP Practice confirmed they have been informed to discharge severely mentally ill from Care Plans if they have not been in hospital for a while, they also confirmed they DO NOT have a COPY OF THE CARE ACT 2014.
The Question is where is 'integration' and who gave instructions to discharge LTC from Care Plans, was it the CCG or the LA, either way there are still serious issues in the latest CQC GP Inspection process.
The CQC have been the only organisation that have listened to the neglect i have found with the new executive team now running my hospital i agree with Johnathan Feildens comments my only worry is the level of inspection that can be done to make sure that the CEO who controls everything is dealing with patients in communicating with them and not just giving his own views of what is happening i.e on their website he praises the fact that they have done 404 operation out of 404 i have waited 2 years so to get the hospital caring with staff caring the top person has to get a complete investigation from Patients, staff, and department leaders
I have disabilities and employ private Care Agencies. I have tried several Agencies and there have been serious issues with all of them. The support cover is inadequate. It can take months to be allocated a carer and then when they take holiday, are off sick, or have training days, I am left without care cover. I cannot get random care cover, so cannot attend events that I would like to, and have missed hospital appointments due to carers arriving late. The carers are unable to do what I need them to do. I am taken advantage of by some carers. My safety has been put at risk at times. I am ignored, undermined and dis-empowered. Although I have a Personal Budget, I am at risk of losing it if it continues to be under used because of poor care provision by Care Agencies. If I report issues, I am at risk of having support withheld, or worse still, being told that I am not a suitable client for the Agency. This is the downside of needing care support, and I don't see it improving any time soon!