Health and Social Care Committee
Oral evidence: Pre-appointment hearing: Chair of the Care Quality Commission, HC 656
Wednesday 9 September 2026
Ordered by the House of Commons to be published on 9 September 2026.
Watch the meeting
Members present: Layla Moran (Chair); Danny Beales; Jen Craft; Josh Fenton-Glynn; Andrew George; Joe Robertson.
Questions 1-56
Witness
I: Baroness Julia Neuberger DBE.
Witness: Baroness Neuberger.
Q1 Chair: Welcome to this one-off session of the Health and Social Care Committee, a pre-appointment hearing for the chair of the Care Quality Commission. It is very much my pleasure to welcome Baroness Julia Neuberger DBE, the Government’s preferred candidate. Thank you so much for joining us this morning.
May I start with a bit of a preface? Ever since this Committee has been meeting, and indeed before that, it is fair to say that the CQC has received significant criticism on its performance. We have had numerous hearings with it over the years, at times feeling slightly more hopeful than not, but I must be honest: I start this appointment hearing feeling relatively down in the dumps about the fact that we have not got further than we have. Could you explain to us and the public why you want to take on this role right now?
Baroness Neuberger: You are questioning my sanity, I think.
Chair: Maybe.
Baroness Neuberger: Okay. Let me start by saying that I am not sure I really wanted it in that sense. I am still, for the next couple of weeks, chairing two NHS trusts: UCLH, which is a foundation trust, and Whittington Health, which is not. I therefore have experience of the CQC from the user end—organisations that are inspected by the CQC—and the experience has been singularly mixed.
The thing I feel most strongly about—this is, I suppose, a public service point—is that we have to have a really effective, trusted and respected regulator in health and social care. It does not have to be loved, but it has to be respected and its inspectors have to be respected. That is not the case at the moment. It is better than it was, I have to say—certainly better than it was a year or 18 months ago—but it still has an awfully long way to go.
Q2 Chair: Can you pinpoint how it has lost respect? What is it that you would seek to turn around?
Baroness Neuberger: It is not one thing. CQC began not to do nearly enough inspections, so it had a huge backlog, and a huge backlog of registrations as well. Then there was a sense within the service—whether or not it was fair I cannot judge—that it was trying to catch up, so that it was not doing them as thoroughly as it might have. Also, the reports of inspections were coming back incredibly late. People were finding that they got two different judgments at the same time. It just felt chaotic. I think if it feels chaotic, you do not have respect.
But I think it goes deeper than that. I think that is the question you are asking me, but I am not there yet; you will decide whether I will be. However, I think CQC has become quite demoralised as an organisation. Demoralised organisations—I do have experience of those—do not function terribly well and do not have confidence. So when they do an inspection, they do not have the confidence that they might have had if the organisation itself had felt held together—or felt held, actually. That is at the bottom of all the rest of it.
I think losing Julian Hartley very quickly after his appointment was a real problem, and Mike Richards’ resignation was another. CQC felt unstable and the staff felt that they had not had the kind of leadership that would make them feel they were respected by their leaders and were held, while also being told when it is just not up to scratch. That is at the bottom of a lot of it, but the symptoms are delays, inadequate performance and feeling a bit of a mess and a bit sad.
Q3 Chair: It is worth saying that many people working in the CQC will be very interested in this hearing. When we criticise, it is not individuals who work below the executive team level that we are aiming at, but it is important that we have a fair and frank discussion about the turnaround. Would you agree that this is a turnaround job?
Baroness Neuberger: I think this is a turnaround job, and that is why I want to do it.
Q4 Chair: What experience do you have of turning around organisations at this level of turnaround need—to put it mildly—and of size?
Baroness Neuberger: Not of its size, but of need, yes. I can give you two examples. I arrived at the King’s Fund as chief executive, not chair, a long time ago—this was 1997—when it had lost a lot of money and had to reduce its size by half. It had to look closely at what its purpose would be. The King’s Fund is a small organisation, and smaller now than it was then, but it did have to be a complete turnaround, and we did it. It got its confidence back and I hope—I think—it did some remarkable things once it had got its confidence back.
Q5 Chair: What did you learn from that experience? What will you bring to this turnaround that you learned from that one?
Baroness Neuberger: The first thing we need to do is meet the people who work within the organisation and meet the people who are the users of the organisation. There is a huge amount of listening to do. 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. We need to give the people within the organisation and the people who use it or are inspected by it—and the public, as the public after all have to trust the CQC—the confidence that we are listening and that then we will take some actions.
Many of those actions have actually already been taken. I want to say that Kay Boycott as acting chair, with her team, has done a remarkable job in quite difficult circumstances since Mike and Julian have gone. The performance is significantly better than it was. I have not gone in, but I am told that staff morale is on the up.
Q6 Josh Fenton-Glynn: In your replies to our questionnaire, you said that you “hope to help the CQC get back to that position of trust and respect”. I worked for another regulator before I came to this place and have been the head of a social care department, so I have been regulated by the CQC. “Trust” and “respect” were not the words that came to my head thinking of the CQC. What are we going to do to get that back?
Baroness Neuberger: As I said before, a lot of listening, but also—this is more the chief exec than me—really thinking through how inspections are done, who carries out the inspections and whether we can use more inspectors from different areas across the country, and doing something to make people feel that it is fair. I have a daughter who is a psychiatric social worker, so she too is regulated by the CQC. I think it is that: people need to feel that it is fair. If they feel that it is fair and if they meet the inspectors and have some respect for them, I think you grow the respect.
Q7 Josh Fenton-Glynn: From my perspective, looking in from the outside, I noted two problematic things about the CQC. One was the internal relationships and internal structures; the other was how it interacted with those it regulates. I would posit that the former is quite tricky to deal with, but is much more within your gift than the latter. You talked about transparency. What else might you be able to do to build confidence with those you regulate?
Baroness Neuberger: I think it is about the nature of the inspections. You have been inspected. I have not yet been out on an inspection, but that is one of the things I will do. You do not have to be there for the whole inspection, but you have to see it in progress. I have only been on the other side.
Q8 Josh Fenton-Glynn: How did you find being on the other side?
Baroness Neuberger: I was not directly in the room on the other side. In fact, UCLH is being inspected at the moment and I am recusing myself for obvious reasons, which is a bit of a shame; I would have quite liked to be on the other side, but I do not think it is right. From what I hear, it is mixed. You have a combination of people saying that they had a very good discussion with inspectors and, while I would not say it was a benign process, that it felt like a fair process.
Q9 Josh Fenton-Glynn: I imagine that it is a collaborative process at its best.
Baroness Neuberger: Yes. It was collaborative trying to find things out. Then you get the report and can send back things that you do not think are right, and all of that. That feels quite positive.
Equally, I have heard of the CQC picking up on something very minor but missing something very major, including—this applies to the internal stuff within the CQC—where the atmosphere in a particular department is quite tricky or even hostile.
Q10 Josh Fenton-Glynn: Any inspector will have trouble with those they inspect, because there is a lot of anxiety. You will have seen that the Government have done quite a lot to change the way Ofsted works, because of the detrimental impact it was having on headteachers and so forth. One thing it did was move away from the single-word assessments of schools. Does it make sense from a policy point of view that, at the same time that Ofsted moved away from single-word assessments because it did not think they properly summarised what a department or school was like, the CQC moved in the opposite direction and brought in a single assessment framework for local authorities?
Baroness Neuberger: I do not think I can comment on that yet. However, I have to declare that my son is a headteacher regulated by Ofsted, so I hear quite a lot about Ofsted. I need to look at how it works before I can comment on that. In plain policy terms it looks a bit odd, but I would have to look at it. I cannot comment on that yet.
Q11 Josh Fenton-Glynn: One thing the Dash review found was that there is limited information available for providers and users, so they do not know what good care looks like under all the ratings. You have had so many roles around health and care. 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?
Baroness Neuberger: I cannot say that I know with confidence exactly what they would look like. I think I know from experience of chairing health organisations that you can feel what a good institution feels like. Sometimes people say—I think I even share this view, and it is certainly true in social care—that you can do it by smell. I know that sounds absurd, but it is true.
Josh Fenton-Glynn: I know. I have walked into care homes when I was a cabinet member for social care in my authority.
Baroness Neuberger: There are various things that you get a sense of. For example, you get a sense of the confidence of staff to speak out. Those things are part of what good looks like, but I cannot say, “This is good. This requires improvement.” I need to look at that in much greater detail with the new chief exec. We will do some thinking about that, but the first thing I want to do is restore some confidence.
Q12 Josh Fenton-Glynn: Do you think it is altogether obvious enough to the public what the different ratings will look like?
Baroness Neuberger: The public find it easier to understand the single assessment rating than people working in the service, because the closer you are to something, the more nuanced it always is. The public probably does not have as much of a problem with “good” or “requires improvement” as we do.
Q13 Danny Beales: We have talked about the complexity of turning around the organisation, which has seemed in freefall, and the length of time that might take. You mentioned the conveyor belt of leadership, which has been destabilising. It all points to the need for stability and long-term effort. How long do you envision that task taking? How long do you envisage yourself in the role of chair? Is it the length of time needed? Do you have the ability to commit to it?
Baroness Neuberger: I am old, so I will clearly not do it forever, nor do you expect me to. We will know whether we are on the right track within a year, and I would commit to doing at least one term. By then, I will be really quite old, and I had always thought that I would be out before I was 80. That probably remains the case, but let us see. We will know within a year whether it has stabilised, and its performance has considerably improved, which it is already doing, so that is quite important.
Q14 Danny Beales: Are you indicating that a year is a check-in point for you or the executive team?
Baroness Neuberger: For everybody. For you, for that matter.
Q15 Danny Beales: Do you think that 12 months and then potentially further change is helpful?
Baroness Neuberger: I do not think it requires further change—I would rather hope not—but you can get a sense within an organisation if it is going in the right direction, usually within 12 months. It might be 18, but it would be that kind of time. It takes a long time for staff to feel really confident in leadership, and they need to do that to do their job better. That will help confidence in the regulated community and will ultimately increase public confidence, I hope, but I would have thought we would know the direction of travel within a year.
Q16 Danny Beales: There is an old adage that you need to give a new football manager some time; you might lose a few games initially, and it might not be the best first season. For people in business and MPs, it takes a year to get to know just the fundamentals of an organisation—the rules, the business and compliance practices. Is it realistic to expect to see the organisational change in a year, bearing in mind the journey it has gone through? To challenge you again, does a leadership team or an executive team not need a significant number of years to turn it around from where it is to being—not to avoid a single-word judgment—a good organisation?
Baroness Neuberger: I did not say it would be a good organisation within a year. I said that within a year you would be able to feel whether the direction of travel was going the right way. I cannot do the football analogy because I am no good on the football stuff, and I still get lost in the House of Lords even though I have been there over 20 years. I absolutely accept that it takes ages, but when people start to feel better about the feel of an organisation, you can tell, and you can then say, “It’s going to take us another two, three, four, five years to become the good or the excellent organisation.” You can talk to schools’ leadership about that as well, but you do know quite quickly whether it is feeling better. You can feel it in your fingertips before the performance indicators show you.
Q17 Danny Beales: I agree on holding the senior leadership team to account to deliver that journey of change over five years. My challenge to you is whether you are committing to do that over that period of time? From a board and governance perspective, having constant change in the chair and the board can undermine holding the executive team to account on delivery.
Baroness Neuberger: I completely agree. I will definitely do one term. I will be quite old, as I said. The point is, how much longer would they want with the old bat, and how much longer would it be useful for me to do the job? I will definitely do one term, and if it seems right, I will continue, let us say for a year or two, but I do not think it is right to be in a position where they want you to go. I have been extended twice at UCLH; they have wanted me to stay. I have got to go now. 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 happened.
Q18 Chair: Who tapped you on the shoulder to do this?
Baroness Neuberger: The Department.
Q19 Chair: Who?
Baroness Neuberger: The permanent secretary.
Q20 Chair: Okay. Did you know the perm sec before?
Baroness Neuberger: Very slightly. I had met her once.
Q21 Chair: What was the approach? What did she say to butter you up?
Baroness Neuberger: Let me say that I did not say yes first time.
Q22 Chair: The delay of four months in the recruitment of the chief exec in particular, has been pretty appalling. Did you discuss that with the Department? Are you any the wiser as to why they could not sign off any recruitment?
Baroness Neuberger: I have not discussed that in detail, but I was involved at that stage as an independent in the appointment of Emily.
Q23 Chair: So you have met Emily Miles?
Baroness Neuberger: Not yet. In fact, we are going to have a coffee after this. But I was on her appointment panel.
Q24 Chair: I understand. Did you know her from before?
Baroness Neuberger: No.
Q25 Chair: Okay. What is your style of chairing? Are you a very involved chair? Are you a daily check-in kind of chair, or are you a hands-off come-to-me-if-you-have-a-problem chair?
Baroness Neuberger: Not quite any of those, really.
Q26 Chair: Those are the two extremes. You are welcome to land yourself on the spectrum.
Baroness Neuberger: I think I am quite collaborative. I have always had in any organisation I have chaired, or the other way round when I have been the chief exec and I have had a chair, a very good working relationship with the chair, or the chief exec—whichever it happens to be. In some cases, they have become my friends after I have no longer been in the position. I do not think you want to have a close friendship because it is a working relationship where you are holding somebody to account.
I am very collaborative. I like chairing organisations. I like pulling a team of directors together. I like the feeling that you make decisions together, but then different members of the board actually carry them out or are responsible for ensuring that they are carried out. I suppose I try to be a kind of supportive friend to the organisation as chair. In my time as chair of the two NHS trusts, I do a lot of walking around and meeting staff, and I think that is quite valuable so that they feel that, should they need to, they can come and talk to me and I have an open door.
Q27 Chair: How far into the weeds of the detail do you like to get? I ask because this is not a full-time role. It is more or less a half-time role. Do you think that will be enough time, given that you do not have regulatory experience and you will have a lot to learn? How are you going to balance the fact that, at the beginning, maybe it will not be a half-time role?
Baroness Neuberger: It won’t be half-time at the beginning, clearly. Apart from anything else, if you are going to go around and meet people and talk to them, although there is a lot of remote working and a lot will be online, it will not be half-time at the beginning. It will be probably quite a lot less as it goes on, but it will not be half-time at the beginning. I am well aware of that and up for it because this really needs to be done. We really must have a regulator that works and is respected. I would expect to do three and a half or four days, certainly at the beginning. I would expect to work very closely with the chief exec at the beginning and work out who is going to do what, how much we are doing together, how much we do separately and all of that. I think it will be a lot of time at the beginning. I am sure that Kay Boycott, who has been acting as chair, has been doing more than two and a half or three days a week.
Q28 Joe Robertson: I would like to put a challenge to you, if I may, and invite a response. In your questionnaire, and indeed in the session today, you have effectively acknowledged that you have relatively little regulatory experience. Does that present a problem? If so, how are you addressing it?
Baroness Neuberger: I don’t think it presents a problem, as such. I will learn. I think you can learn that quite quickly. 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 will learn. My last proper regulatory experience was in the GMC very many years ago. Regulating doctors individually is very different from what the CQC does, but I have been within the service and know a fair bit. I have also seen quite a lot of regulation within the care sector. Seeing it from the other end helps you to understand a bit of how it works. I will have to learn the detail and technicalities of regulation, but that should be all right.
Q29 Joe Robertson: Are there any other gaps that would require you to do some learning—potentially even some gaps that are not covered by the combination of you and the chief executive? Are there any other areas that you would like to reflect on?
Baroness Neuberger: There are some things the CQC absolutely needs, like a really good IT system. I have not talked to Emily about this, so I do not know what her expertise in IT is, but mine is not great. We will need to have serious expertise in IT on the board and we need to think about that very hard. That is particularly true with AI and all the things that are happening there. We need somebody on the board who is absolutely up to speed in all that. Emily and I, and the board as we have it now, do not have all the expertise that we would need.
Q30 Joe Robertson: Finally, social care and the vital role that local authorities play in it is often treated as second class to NHS and healthcare across the whole sphere of policymaking and spending. Do you see any issues within the way the CQC operates that fail to elevate the importance given to social care and the way it is regulated?
Baroness Neuberger: I am not inside the organisation yet, so there are some things that I cannot comment on, but oddly enough, most people I have talked to externally find the inspection in the social care area more satisfactory than in the health area. That part of the work seems to have greater trust. Although I think quite a lot of social care providers find it quite irritating, there is quite a lot of respect there. By the way, I ought to say that wearing a different hat—a private hat—I am quite involved in some work to up the status of care workers within the social care sector. I am a trustee of the Rayne Foundation, and we are doing this thing called “Better Careers for Better Care”, which I am deeply involved in. I see quite a lot of social care at the moment. I will stop doing that in December anyway.
Q31 Danny Beales: We briefly touched on the Dash review, but I wanted to bring you back to the Dash and Richards reviews. What lessons do you take from them?
Baroness Neuberger: Both were pretty thorough looks. Of course, the Richards review was done before he became chair. I ought to say that Mike Richards is one of my closest friends—he is a very old friend; we go back to our student days. What would I say? What you learn is that when an outsider who is not a complete outsider looks at an organisation, they can identify some things that people within the organisation do not seem to be able to see—I think that is often the case, by the way. In both cases, they did some very useful things on detail but as I said before, I cannot comment yet. On the HSSIB point, which I think that you very much take to heart, would I have started from here? No. I don’t think that I would necessarily have gone with the recommendation of HSSIB going into the CQC, but that is where we are.
Danny Beales: We might come to that.
Chair: Yes, we are going to come to that.
Baroness Neuberger: That recommendation comes out of the Dash review, which is one of the reasons why I raise it now. I think that you look at the review and what you can learn from it. Did they spot things that the organisation itself cannot spot? Yes, almost certainly so. What do you do with it? I am very happy to talk further about HSSIB.
Q32 Danny Beales: You are right, it identifies quite a lot of significant issues. Do you come away from them with any sense of priority? Do you think, “I must do this on day one. This is top of my list”?
Baroness Neuberger: Not from the reviews. I think it is much more from what I have learned from being in two health organisations, and from talking to people in care organisations, which I have been doing quite a lot because of the Rayne Foundation work. It is much more from the people that have experienced inspection and also from the public and publicity generally about the CQC and inspection and standards.
Q33 Danny Beales: I know we will come to that issue in a bit, but there has been a widening of scope of the role of CQC at the same time as existing challenges in delivering its responsibilities. Do you have a sense of where the balance and priority should be? Should it be doing new things better or focusing on the fundamentals of the existing responsibilities and backlogs?
Baroness Neuberger: Of course you have to do that. You must get the basics right before you can take on the new, in my view. Wes Streeting, when he was Secretary of State, said that that the CQC would not be taking on HSSIB until it was ready. I agree; I think that is right. There is a difficult point in judging when that time is right—that is the point that that you made—but as I said before, I think you can sense the direction of travel within a year.
Assuming that the legislation goes through and the decision remains that HSSIB goes into the CQC, we would make it work. But I would hope that the CQC would be given enough time under mine and Emily’s leadership to stabilise the ship and to get those basics, as you describe them, right and begin to get the respect back. I am thinking about the early days of the CQC and 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.
Q34 Danny Beales: I think it has been said that the CQC is “not fit for purpose”—those words have been used. Are you confident that it can be saved and that it can be turned around and be a respected, well-performing organisation?
Baroness Neuberger: I think so. I am not inside, and I will very deliberately not be inside until you confirm me or otherwise. Do I think that it can be turned around? Yes. The evidence is that its performance is getting better. Kay and Arun have provided that leadership. The team have provided that leadership and we can see performance improving. Do I think it is possible? Almost certainly yes. I will be able to tell you a bit more when I am there. But do I think it is possible? Yes. It is going to be quite a big job though.
Q35 Danny Beales: As well as providing assurance about the quality of care, there are, unfortunately, instances of quite serious failure of providers of different sorts. Unfortunately, we have seen them far too frequently. The Committee is looking at St Andrews in relation to mental health. I think we are going to come to maternity later. There will be more questions specifically about that. Does it worry you that in all of those instances the CQC has actually been there at different points? People have been harmed. There has been serious failure.
Baroness Neuberger: Yes. Of course.
Q36 Danny Beales: What do you think the CQC’s role in action should be? How quickly should it act? Should there be quicker intervention from the regulatory state when concerns like this are evident? In a number of instances, it feels that it is many years before national inquiries are eventually called, but the regulators, the people who should be assuring people’s safety, have often been there right from the start.
Baroness Neuberger: I agree. I expect a regulator to flag stuff up. You are not always going to be able to do it. Obviously, regulators are not always going to see where there are problems. Very often you need an inquiry for a particular thing, but if the regulator has found things that are of serious concern, I would expect that to be flagged quite quickly.
Q37 Danny Beales: You said that you believe there are signs of improvement. On culture specifically, I think recent surveys have indicated a decline in staff confidence. That might not fully reflect more recent leadership changes due to time periods and lagging, but it identified concern about being supported by leaders and not being listened to enough. You talked a lot about listening being a priority and concerns not being acted on. What is your view of the organisational culture and staff morale?
Baroness Neuberger: I am not there yet, but from what I hear it has been quite low. I suspect that there is probably a bit of a lag with the staff survey, but that is one of the first things I would want to address with Emily. You need to have staff morale up to get the confidence back. It is absolutely essential.
Q38 Danny Beales: Are there particular actions that can be taken to do that?
Baroness Neuberger: The first action is simply to get to know people. I know that sounds ridiculous, but it is true. One of the things that I have done a lot of in my time chairing both NHS organisations is going to see people at work and also saying thank you a lot. Some of those things are quite basic, and I suspect we need to do quite a lot of that.
Q39 Danny Beales: Do you think the previous chair and board or leadership team were not doing that? They were not saying thank you.
Baroness Neuberger: I think they probably were, but it all felt chaotic and then Julian left very quickly. Do not forget that Julian Hartley instituted quite a lot of changes, brought a lot of people in and then left very suddenly. That is really hard for an organisation. They do not feel held any more. I think the fact that Emily and I will come in at roughly the same time—I am a couple of weeks earlier—is quite helpful. We will both be there and both be listening. We will probably listen in different ways and speak to different people, but we will both be there. That is quite important.
Q40 Danny Beales: Finally, how will you know when the organisation’s culture has changed? How will you be confident that the morale and confidence has turned around?
Baroness Neuberger: As I said, you can feel quite a lot of it. Of course, there is the staff survey, although it will lag. At UCLH, we always do incredibly well in the staff survey, and that tells you something about the culture of the organisation. That is important. I believe that organisations function well when staff feel supported and feel you are fair. Sometimes you will not necessarily agree with them or you will think that some people are not doing a particularly good job—but you will be fair.
Q41 Andrew George: In answer to that last question, you referred again to your emphasis on feeling—the feel matters, and you can smell whether an organisation is up to scratch. Is there not a risk that, without some objective means of measuring that, you fall into using the mores and metropolitan clubbability of the people you meet? You talk about your friendship with Mike Richards. Is there not a risk that you are working within a bubble of smell and feel, and are not sufficiently self-reflective to see what is really going on?
Baroness Neuberger: No, I don’t think I am saying that. You need the rigour of metrics. The staff survey is one way of getting a metric on how the staff are feeling. But, as I said, there is a lag, so you can usually pick up a change before you can see it in the metrics. Equally, with a hospital or care home, the inspection inspects against standards, which are objective, so you can tell the direction of travel from that. But again, you can usually get the feel of it before you get the metric. That is all I am saying. On the metropolitan bubble, it is probably fair to say that, although Mike Richards is one of my closest friends, I do not think that he thought it was a great idea to become chair of the CQC. I am not sure it was a wholly happy experience for him. I am doing it because it needs to be done.
Andrew George: Can I offer another smell or feel, which is on the ground where I live and operate in west Cornwall? People there do not feel confident that the CQC is doing its job or undertaking sufficient inspections. The impression is that if people are going looking for a suitable care home for their loved one, they have no confidence that the CQC has provided them with satisfactory information. The smell and feel out there is not a good one, whereas you are getting the impression that it is improving.
Baroness Neuberger: No, not yet, but I am getting the impression—which may be wrong—that there is less dissatisfaction with the inspection regime on the social care side than on the health one. That is all I am saying. If there is dissatisfaction with how the CQC inspects care homes, that is something we should take extremely seriously. Assuming I am in post, along with Emily and the people in charge of inspection of social care, I will look at that. I do not think I would take anything for granted.
Q42 Andrew George: On Emily—who I am aware is present—there has been some observation that she does not come from a health and social care background; I think she currently holds a DEFRA role. How confident are you that it is appropriate to have a chief executive without that background experience? Do you think that she can realistically get up to speed with the nature and complexity of the sector in which she will be asked to operate?
Baroness Neuberger: Yes, I think she can. She is a regulator, which I think we absolutely need, and she has experience of that, and I come with the health and social care experience. We also have a board with health and social care experience—actually, it is a board that does not have enough regulatory experience, in my view. The board has quite a lot of health and social care expertise, and specific individuals who are the leaders for particular areas of inspection and who are experts themselves. I think that is fine.
Q43 Andrew George: Returning to the subject of HSSIB, which you raised, and the appropriateness of bringing an investigatory body into a regulatory body, that merger has been subject to significant comment and criticism. HSSIB is admittedly a relatively young organisation, but it has a good reputation and is much admired by people within the sector as a harbour to which they can report matters of concern. How satisfied are you, looking at it as someone coming in from the outside, that it is a wise move to take that risk?
Baroness Neuberger: Would I have done it in the first place? No, but we are where we are and so we will make it work.
Q44 Chair: The Lords could still save us if they chose to.
Baroness Neuberger: I cannot comment on that, can I?
Chair: Maybe they will.
Baroness Neuberger: Yes, but let me say, assuming that it goes ahead, which to be honest is probably likely, we would have to make it work. That means having Chinese walls and making sure that the CQC is itself in a better place than it is now before it happens. That is all I can say.
To me, it seems that they are different kinds of bodies. In that sense, would I necessarily have done it? No. But that is the Government’s decision and if that is what happens, the CQC will make it work. But I think we would want some time before that even happened.
Q45 Andrew George: I am encouraged by the approach that you are taking, and I would not necessarily say that you should express the view publicly in more trenchant terms, although I would like it.
Baroness Neuberger: We are in public.
Andrew George: We are, absolutely. Do you not think that it is appropriate that, on coming in, you should be able to express your view very bluntly to the new Secretary of State and that where you feel uncomfortable about such a merger, that view should pertain as well, even during the passage of the Health Bill?
Baroness Neuberger: I could not possibly comment, but I am talking to the Secretary of State.
Q46 Andrew George: That is very helpful. You talk about Chinese walls, but there is also the risk of Chinese whispers. The problem that a lot of those in the sector are worried about is that HSSIB provides a safe space for clinicians to raise concerns without fear of getting into complex litigation. That seems to be a very attractive option and one that would advance patient safety. I cannot believe that those within the CQC would be prepared to take the risk of going into a world where there is a lot of uncertainty about whether it is going to work through the merger.
Baroness Neuberger: To some extent, they may have to, so let us see where that goes. Assuming I do this role, I am happy to come back when we know exactly how it is going to work. I think I agree with you; it is the safe space bit and how you keep that completely separate that bothers me. I think we would make it work, but as an outsider at this stage, I cannot say exactly how. That is something that Emily and I will want to talk about very quickly along with Kay.
Q47 Jen Craft: I would like to turn to maternity services. You will be aware that Baroness Amos told this Committee that in her review of maternity services, she found “significant regional variation in the way that the CQC operates” and often “insufficient expertise” to adequately inspect maternity services. 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? Crucially, how will you make sure that the public have confidence in the CQC’s ability to do so?
Baroness Neuberger: Let me say that what has been going on with maternity is one of the reasons that convinced me in the end to say yes, because I am so worried about it. I am deeply concerned about what Baroness Amos has said, what Donna Ockenden has said and what we are hearing. Very early on, I want to sit down with Emily and the team and look at that in great detail.
I suspect—but I may not be right—that if you looked at other areas of practice, you would also find situations where there was not adequate expertise always among the inspectors. That is something that we need to look at very closely and work out how we make sure that there is adequate expertise and that the group being regulated—the maternity department, wherever they happen to be—feels that that is being done fairly.
The other thing that is happening at the moment—I speak as the chair of two providers—is that the maternity departments themselves are now incredibly worried, scared and all over the place, and midwives particularly. It is becoming increasingly difficult to recruit midwives. It is a huge issue. We have to look at how maternity is regulated, but we have to look at how everything is regulated, look at the expertise and then make sure that those who are being regulated feel that it is—that awful phrase—firm but fair. Then I think the public will begin to get their confidence back, but we will look at it very quickly.
Q48 Jen Craft: I know that you are still an outsider. Do you think there is potentially a cultural issue in the way that inspections are carried out? Do you think inspectors have the right frame of mind as to why they are there and what they are doing? For example, in adult social care, care agencies can be inspected and given a rating by the CQC without anyone actually ever visiting any of the sites in which they operate. I am confused as to how you would be able to visit a nondescript office, carry out an inspection and say, “This care agency is good,” or even more. Do you think there is an issue in the way that those inspections are carried out, and do you think the inspectors themselves have the right attitude and understand what they are there to do and why?
Baroness Neuberger: I am not there, as you rightly said. I suspect people would not be inspectors unless they had the right attitude and the right underpinning desire to make sure it is working well and, to some extent, to make sure it improves.
But there is something that worries me considerably, and that is the extent to which the user voice is heard. That is a much more general point than about the CQC. I started in all of this as chair of the Patients Association a million years ago. I do not think the CQC is good enough at listening to the user voice. In maternity, the sort of thing that you might expect is scanning Mumsnet or something like that. You would expect more of a scanning of what is going on outside, to inform the culture of inspection. That is one thing.
The other thing is that I think there is a general lack of user voice. In fact, in terms of social care, often it is family and carer voice. That is something that needs to be looked at.
Q49 Jen Craft: Thank you; that is really helpful. Just to clarify, is it currently the case that a maternity unit would be able to get a “good” overall rating if they were rated as “requires improvement” on safety?
Baroness Neuberger: I cannot comment on that. I am not aware that it is, but it may be. I do not think so.
Q50 Chair: For context, that came from my trust. Oxford University Hospitals trust’s maternity unit became part of the Amos review because there were a large number of failures. Vocal groups had written to the CQC over a number of years with their personal stories and nothing happened.
Baroness Neuberger: The personal stories that are not being taken seriously is the bit that worries me.
Chair: They will have been heartened to hear about your approach.
Q51 Jen Craft: In terms of putting the user voice front and centre, how would you look to do that? How would you make sure that everyone who works for the CQC is aware that that has to be part of their focus, as well as everything else that they are looking at?
Baroness Neuberger: That is part of the culture change, and it is part of the leadership that I would hope that Emily and I would provide.
Q52 Chair: I am very grateful for your answers on maternity in particular. The lag between inspections was something else that came out of our experience in Oxford. The unit was rated as “requires improvement”. It made improvements quite rapidly, but then there was no planned reinspection for a very long time. Meanwhile, the community was saying, “It’s not safe to have your baby there.” I had to beg by all means possible for the CQC to come to reinspect, and now the unit is “good” again, but the parents point out that there are still some concerns around safety, so I urge you to look at that. I know that that is reflected in other areas, where too often the CQC is too late; 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. How do you intend to sort out those sorts of issues? Do you recognise what I am saying?
Baroness Neuberger: I absolutely recognise what you are saying. I come from the provider side—I absolutely recognise what you are saying, but the detail of how we try to sort that out is not for me to comment on yet. That is something that Emily and I and the team will talk about, but I completely agree.
Q53 Chair: Obviously, this role is not just chairing the CQC; it is also co-chairing the beefed-up national quality board. Do you know Penny Dash? Have you worked with her before?
Baroness Neuberger: I know her very slightly.
Q54 Chair: In this broader landscape, where do you see the role of the CQC? You have read the Dash review, but you are the chair of a provider. What role could the CQC play now, but also in a future where it is up and running properly, in that safety and quality landscape?
Baroness Neuberger: If we got it completely right, and that will take some time, it could provide a lot of the assurance to the system more widely—the quality board and beyond—that there is proper inspection, that issues that are flagged are dealt with, that the public are listened to and their concerns are acted upon, and that it ultimately has the confidence of both the broader sector of health and social care and the public. To some extent, it would be the provider arm of quality assurance for the quality board. That is how I assume it would work at best. It is going to take quite a while to get there, but that is what I think it should do.
Q55 Chair: Second to last, I just need to ask, beyond what you have told us on your questionnaire, are there any other conflicts of interest that are important for us to know about?
Baroness Neuberger: Not that I can think of, otherwise I would have put them down.
Q56 Chair: Fair enough—that is what we assumed, but it is worth asking, just in case another had emerged in between.
This is my final question. You have mentioned a year a number of times and have said that we will be seeing significant progress in a year’s time. Let’s fast-forward, and I appreciate that you are not there, but play with me. If we were to have a session like this in a year’s time, maybe also with Emily, what sort of metrics should we be looking at to start to see that success? What would you hope to be able to bring to our Committee to show that that direction of travel is not just starting, but starting to take hold in the organisation?
Baroness Neuberger: I would hope that you would see the improved performance that you are 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. I hope you would hear from provider organisations—and we would probably want to measure that in some way—that they are more content with both the frequency and the manner of inspection. I would have thought that you could measure some of that within the year.
Chair: Let’s see. Maybe we shall have you back, but for now, that brings us to the end of our questions. Thank you for joining the Committee this morning. We must now be left to deliberate.