The Healthcare Commission has invited views on what it should include in the second annual health check. The message from NHS Confederation members is that regulation must not be seen as an end it itself. It needs to be about helping NHS organisations improve their services for patients. There are real problems already with the weight of regulation in the NHS and they should not be added to. If there was stability in the Healthcare Commission's assessments it would be a great help so NHS organisations have time to embed the new system in their practices.
The Healthcare Commission plays a vital role in assessing performance of NHS organisations and reporting results on an annual basis. Regulation plays a necessary part in health in terms of providing public assurance about the quality and safety of services as well as value for taxpayers' money. It is also crucial for NHS organisations themselves to help them achieve better governance.
However, there is a careful balance to be struck between good regulation that can have a role in helping trusts drive improvement and bad regulation, which due to its enormous scope and burdensome nature, has a negative impact on services. The human and financial cost required to demonstrate compliance can outweigh the benefit. Regulation is bad when it stops adding value and causes a greater burden of bureaucracy than is necessary or helpful.
The latest Healthcare Commission consultation on the annual health check for 2007 / 08 comes dangerously close to tipping this balance. This is for three main reasons.
First, whilst the Government has undertaken a wide regulatory review that aims to reduce bureaucracy and streamline regulatory functions, the Healthcare Commission is extending its remit and responsibilities. We must be careful this does not border on performance management. This is a totally different concept to performance assessment and reporting to the public on the state of healthcare. It is right that regulatory requirements must evolve as legislation changes, but we cannot allow endless additions to the annual health check without something giving way. For example, there are currently more than 500 lines of enquiry in the annual health check and demonstrating compliance with this ever growing framework without prioritisation is going to become more and more difficult and costly for NHS organisations.
Second, we need a framework that prioritises the biggest issues for patients; measures patient outcomes rather than processes; and leaves the development and improvement agenda to individual NHS organisations. The Government has made a commitment to a bottom up, more streamlined system. If we are serious about a reformed NHS where independent, self improving organisations compete based on quality rather than cost and commission high quality services based on patient choice and voice, then we must not send conflicting signals and allow the regulator to micromanage. This will only serve to stifle NHS innovation and delivery.
Third, the key to a successful regulatory regime is avoiding a complex and bureaucratic system. For a future regulatory framework to be effective we need consistent and transparent roles for all those involved in regulatory functions - not least the Healthcare Commission - and for the principles of better regulation to be properly adopted. Finally, we need recognition that it is individual boards that are responsible for driving improvement and that the role of the regulator in this respect is to help and assist this process and report on performance for reasons of public assurance, not to monitor and manage performance.
Our members look forward to working with the Healthcare Commission on getting the balance right as we move forward. The merged regulator will need to look at and consider these issues carefully to ensure that we have a regulatory system fit for its purpose and one that helps not hinders our drive to achieve a patient focused, world class service.
Dr Gill Morgan DBE
Chief Executive
NHS Confederation
HSJ online, 23 April 2007
