Patients and care-home residents may not immediately notice the difference, but the quality of health, social and psychiatric care in England will soon be the responsibility of a single “super-watchdog”.

Forged amid Gordon Brown's “bonfire of the quangos” in 2005 — an attempt to cut a perceived culture of over-regulation — the Care Quality Commission (CQC) acquired legal status this week. The CQC, combining the Healthcare Commission, the Commission for Social Care Inspection and the Mental Health Act Commission, will oversee how some of the most vulnerable people are cared for.

Baroness Young of Old Scone, the CQC chairman, said: “Hardly any regulators work across both the private and public sectors. There is Ofsted ... and now us. We think of ourselves as the people's regulator, with a working strapline of ‘Making care better for you'.”

From April 1 the CQC will be in charge of registering, investigating and assessing all NHS and private health and care-home providers in England. Much has been made of its new powers, which include fines for hospitals that fail to meet expected standards. However, the CQC will be “faming” best performers as well as “naming and shaming” the worst, Lady Young said. “We want to talk softly but carry a big stick,” she added. “The whole thing has to be about driving up standards; we are the Care Quality Commission, not the care failure commission.” The maximum £50,000 fine is a “slap, not an Exocet”.

“We are trying to make all our approaches as light-touch and evidence-based as possible,” Lady Young said. “Ideally what we want to do is talk with commissioners and providers to improve the quality of care, rather than beat the s*** out of them. We are not going to be riding around the land shutting hospitals.”

Such forthright comments are typical of the Labour life peer, who became a crossbencher when appointed chief executive of the Environment Agency in 2000.

The CQC's responsibilities will include everything from the standard of care-home meals to detention of patients under the Mental Health Act.

NHS trusts will initially be registered on their ability to tackle infections, such as MRSA, with some expected to improve before acquiring full registration.

But can you apply the same standard of quality in a thousand-bed hospital trust as in a six-bed privately run care home or a domiciliary care service for a single patient?

“Piece of cake,” Lady Young replies, half-jokingly. “At the Environment Agency, we were regulating everything from jack-the-lad carbreakers up to nuclear and chemical installations ... We will take a human rights-based approach and build on what the existing commissions have developed.”

Lady Young rejects criticism that “healthcare's from Mars and social care's from Venus”. “The great joy is that we will have a single registration system, which can adapt to what is appropriate for a mum and pop care home or for St Mary's [Hospital] in Paddington.”

She winced, though, when reminded that the new body will be the third health regulator in a decade, and the fourth for social care. “We are determined to keep banging away at the need for a bit of stability now,” she said. “We have to register all trusts for standards on healthcare-associated infections from April 1, all hospital and social care providers from April 2010 and then primary care from 2011.”

Although the fledgeling Care Quality Commission is likely to take three years to find its feet, “the absolute requirement has to be that we continue to regulate over the transition”.

The Lowdown

Who: Barbara Young, Baroness Young of Old Scone, first chairman of the Care Quality Commission (CQC). She was chief executive of the Environment Agency for eight years. Other former posts include chairman of English Nature; vice-chairman of the BBC; a director of AWG, the utility group; chief executive of the Royal Society for the Protection of Birds

What: The CQC will absorb the Healthcare Commission, the Commission for Social Care Inspection and the Mental Health Act Commission, which regulate the work of 2.8 million staff in the NHS, local authorities and the private sector.

When: The CQC came into existence this week. It is to take over from the existing regulators on April 1.

Why: “It is about taking new and decisive action against failing services: establishing a new Care Quality Commission with tougher powers to impose fines and close down wards in the case of poor standards” — Gordon Brown, speech on the NHS, January 2008

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