In terms of levels of public exposure, the health and social care sector is probably up there with financial services. Whether it be Swine Flu, healthcare associated-infections or the tragic case of Baby P, such issues are certain to get feelings running high.
When you consider that such charged issues of life and death are taking place in a country in the grips of recession and poised for a general election, how does the Care Quality Commission (CQC), the sole body responsible for regulating health and adult social care in the UK, avoid becoming a political pawn?
“Through sticking to our statutory powers,” responds the organisation’s head of legal services Louise Guss. “If it’s not mentioned in the Health and Social Care Act  or other specific legislation, we don’t do it. It’s about consistently ensuring we’re doing what we’re here to do.”
The CQC was established in April this year through the merger of previous adult health and social care regulators the Commission for Social Care Inspection (CSCI), the Healthcare Commission (HC) and the Mental Health Act Commission.
Guss herself formerly led the national legal team at the CSCI and its predecessor organisation the National Care Standards Commission. Since taking the helm at the CQC she has overseen some major reorganisation.
“One of my main priorities is being flexible and adapting to the business,” she emphasises. “When we became the CQC I brought together the existing legal teams. I modelled a team that took the best of those organisations. The CSCI was geographically dispersed, while the HC was all in one place.
“I wanted to build upon that knowledge; I wanted people to work together to understand both sides. We’ve undertaken an intense period of training to share health knowledge across social services networks and vice-versa.”
Guss employs a total of 33 people in legal services. Fourteen of these are solicitors dealing with advocacy and the most complex legal matters who are based in both London and the nine regional offices.
So with the recent talk of curbing public spending, has the organisation been under pressure to reduce its overheads?
“We don’t expect to lose any staff in legal services,” responds Guss. “There haven’t been any salary reductions so far, but we’re about to embark on a job evaluation process that could result in some changes.
“There are people from three different teams and there’s obviously a difference in what people doing similar jobs are paid. We’re ensuring everybody’s paid a similar amount on the grading process.”
Guss is also cognisant of the costs involved in going to her 12 panel firms. She currently has an external spend in the region of £1.4m. Most of the work is handled in-house, but niche work, such as employment, complex property and IT issues, as well as some litigation, is typically farmed out.
“We’re making sure we’re keeping external costs down – talking about rates and being tough. We’re going to have to become tougher,” points out Guss.
A big change for healthcare trusts up and down the country will occur as of next year, when the NHS comes into full registration under the Health and Social Care Act. All healthcare trusts are expected to register from mid-January 2010.
“Some providers may register with conditions attached if they work in certain areas,” says Guss, “but if we refuse registration they’ll have to cease practise.”
But is there a risk that some sections of the public could be left wanting if trusts are closed?
“It’s a difficult balance to strike, that’s why we’re putting in robust, cross-checked systems of registration,” she says. “We’re well aware of the issues with regards to provision of services, but there must be a line drawn where the service becomes so bad that it’s better for it not to be there at all.”
As might be expected, the CQC and its predecessors carry out a lot of prosecution work of healthcare providers that are not up to scratch.
“Twelve in the last financial year,” confirms Guss. “And we’re doing quite a few now in-house. We’re quite hot on that. If information comes to us it’s our responsibility to check it out.
“When we receive an appeal the providers have the right to appeal to the first-tier tribunal. We tend to externalise as it’s more cost-efficient. We have between 25 and 30 ongoing at any particular time.”
Guss has overseen a huge amount of change over the past 12 months. But in the coming year, more than any other, there is likely to be a whole lot more.
“Goodness knows how long the CQC will last,” says Guss. “Regulators are regularly recycled.”
Name: Louise Guss
Organisation: Care Quality Commission
Industry: Health and social care regulation
Job title: Head of legal services
Reporting to: Director of finance and corporate services John Lappin
Number of employees: 2,100
Legal capability: 33
Main external law firms: Anthony Collins Solicitors, Bevan Brittan, Browne Jacobson, Capsticks, Field Fisher Waterhouse, Hempsons, Hill Dickinson, Mills & Reeve, Morgan Cole, RadcliffesLeBrasseur, Sternberg Reed, Weightmans
Legal spend: £1.4m
Louise Guss’s CV
1987-90: LLB (Hons), John Moores University, Liverpool
1990-91: Law Society Final Solicitors Examinations, School of Law Chester
1991-92: Diploma in Counselling Skills, Gateshead College
1996-98: LLM (Masters Degree in Law) with Advanced Legal Practice in Practice Management, University of Northumbria, Newcastle
1999-2000: Law Society Diploma in Local Government Law and Practice, College of Law, Guildford
1991-93: Legal assistant, Dickinson Dees, Newcastle upon Tyne
1993-98: Solicitor, Sunderland City Council
1998-2002: Solicitor, Durham County Council
2002-04: Director of legal services, National Care Standards Commission
2004-09: Head of legal services, Commission for Social Care Inspection
April 2009-present: Head of legal services, Care Quality Commission