Another pointless initiative


I spent another depressing evening this week among the deckchair-shufflers as RMS National Health Service sails gracefully towards the iceberg of our ageing population.

It was billed as a chance to meet some of the regulators, like Baroness (Barbara) Young, who's heading up the new Care Quality Commission, and fellow Scot Bill Moyes of Monitor, the NHS Trust regulator.

We were under the Chatham House rule, so I can't tell you what was said. But since nothing was said, that's no problem. I've rarely heard so many platitudes in a single evening. However, I'm sure the good Baroness wouldn't mind me reporting that she began her talk by explaining that she wanted the Care Quality Commission to be 'The People's Regulator'. I missed quite a bit of what followed because I had to leave to throw up.

The CQC, as we must learn to call it, has been given the task of bringing all health and social care, public and private, under the same regulatory umbrella. It replaces quangos that were set up under this government, which is rather an astonishing (and expensive) u- turn. Not so much the 'Not Invented Here' syndrome as the 'Nutty Invention Here' syndrome. The watchdog's 'Initial Manifesto' says it will be 'open, transparent and accountable...tough and fair...guided by care users...' Er, I feel sick again.

I'm afraid that Lady B has an impossible job in seeking to regulate the whole of health and social care. Just as the National Health Service has an impossible job in trying to deliver it. The NHS is too big to manage, and it's too big to control.

We don't need a Shoe Quality Commission to regulate the quality of our shoes. Customer choice and competition do the job perfectly well – and systematically, remorselessly and constantly, through every decision that every buyer of shoes makes. Bad shoemakers get driven out because people who buy bad shoes demand their money back and tell all their friends not to buy that brand. It's probably just as well. A Shoe Quality Commission would probably end up compiling a 7,000-page Shoe Quality Manual detailing rules for everything from the length of the laces to the thickness of each nail. It wouldn't do customers any good at all. Far better if we scrapped the state healthcare monopoly and used the real decisions of millions of healthcare customers to drive up quality. That would be far more effective than leaving it to a bunch of quango-crats on index-linked pensions.