The NHS wants effective and intelligent regulation, not “a simplistic race for more and more inspection”, the head of the NHS Confederation will say today (Wednesday).
Mike Farrar, the NHS Confederation’s chief executive, plans to make these points when giving oral evidence to the House of Commons Public Accounts Committee, which is holding an inquiry into the Care Quality Commission (CQC).
He says:
“I want to be clear that any large healthcare system needs regulation. But we want an effective and intelligent regulator that focuses its attention where it is most needed. It is incredibly important the regulatory system carries the confidence of the public and the organisations regulated. We want the CQC to be a success.
"It is clear the regulator needs to do more to earn confidence. Our members are telling us that the CQC is not always proportionate in its approach and its model of regulation is too generic. We hear inspectors can be inconsistent, processes bureaucratic and guidance inadequate.
“However, this is not a moment to engage in major structural reform of regulation. History suggests we have had too much of that already. While the rest of the NHS is already engaged in structural change, the CQC’s eye must be on the ball. This is not a moment for hiatus and distraction."
Mr Farrar urges the CQC to prioritise:
- focusing attention on greatest risks to patients and patient safety;
- giving people certainty about what the regulator is looking for;
- running efficient, proportionate and consistent processes;
- developing a well-informed workforce that understands the services regulated;
- delivering value for money as trusts are concerned by rising costs;
- ensuring the public are clear about what it can, and cannot, do.
Mr Farrar adds:
“It is important to stress that NHS leaders are not looking to outsource the quality of care to the regulator. It is the NHS that is responsible for quality and we are determined to ensure we provide the safest and best care possible, bearing down on poor performance*.“I hope the public inquiry into what happened at Mid Staffordshire NHS Foundation Trust will help to improve systems for monitoring and regulating the quality of patient care. But there is danger of oversimplifying issues and reaching for easy answers.
“Healthcare is, by its nature, risky. However good a regulatory system, it cannot guarantee safety. What it can and must do is help minimise and manage risks. Doing this successfully requires an intelligent, whole-system approach of which the regulator is just one key part.
"This is where the Government comes in. It needs to clarify the roles of clinicians, trusts boards, commissioners and the plethora of external agencies – including the CQC and the full range of professional regulatory bodies - so that they are complementary.
“From the cleaner and clinician to board director and NHS commissioner, we need everyone pulling in one direction. Keys to success include ownership and leadership.”
On inspection, Mr Farrar says:
“Inspections have a crucially important role. The public takes great assurance from the fact that they are taking place and I understand why.
"But, by their very nature, inspections only provide a limited snapshot in time of the quality of care being provided in an organisation. To go beyond that would risk incurring greater expense and diverting money from front-line patient care at a difficult time for the NHS and public finances generally. The secret is to get the balance right.
"So in terms of monitoring quality, inspection is only one piece of the jigsaw. A simplistic race for more and more will not necessarily deliver safer care for patients.
“The regulator needs a variety of tools, coupled with a proportionate risk-based approach. It needs to vary its approach in recognition that there is a world of difference between assessing care in a GP surgery, a dental practice, a care home, and indeed the large variety of work that NHS trusts carry out.”