The Health and Social Care Bill, published on 16th November, will establish a new super-regulator, the Care Quality Commission, which will bring together into one power house the Healthcare Commission and the Commission for Social Care Inspection.
This is a good thing, but MPs should be concerned about how the new regulator will work. NHS trusts cannot focus on tackling healthcare acquired infections, targeting health inequalities, or finding the best and most effective ways of treating patients, if they spend all their time on bureaucratic accounting. This regulator must not increase the bureaucratic burden on NHS organisations. With over 50 organisations already reviewing NHS trusts, it is time trusts had a simpler way of being held to account for their actions based on patient outcomes.
The new Care Quality Commission must therefore approach its task using a risk based model founded on self-assessment. Any requests for extra information from trusts must be backed up by a clear legal remit so that everyone knows where they stand. If power is to move away from the centre, as all three political parties advocate, trust boards must be the drivers for local improvement, subject to the needs of their local population. The regulator must be part of the framework for helping them achieve this. A system which tries to predict every eventuality with the constant potential for intervention is anachronistic, impractical and financially unrealistic.
We could learn from regulators in other sectors and their approaches. For example, the Financial Services Authority and Ofcom tailor their work according to the type and size of organisation they are working with. This is something that we are keen to see brought over into health services.
In seeking to change the burden of proof required in malpractice cases from the criminal standard to the civil standard, the new bill also follows the methods supported by other health regulators. Doctors are understandably concerned about this but we feel that their concerns are overstated. The bill is not aimed at striking more clinicians off - this should remain a final option that will require the strictest burden of proof. It is about reinforcing public confidence so if they make a complaint, they can be sure it will be dealt with - and rectified - properly.
Finally, we must see continuity with what has gone before. The Healthcare Commission's Annual Health Check will be only 4 years old by the time the CQC is established. It can not therefore take a 'year zero' approach and discard what has gone before. NHS trusts are really starting to get to grips with its new self assessment regime and the last health check showed that many trusts had made impressive achievements.
Equally important to all this are patients and the public. Regulation is not a question of branding or a reaction to the latest crisis. For the public, it is about reassuring them that their money is being spent properly. For patients the key is that they are going to be treated safely and with care. It is pointless having a new regulator if the public are suspicious that it will be replaced with a new one sooner rather than later which will introduce yet another regulatory regime that will make comparisons on the progress of its local hospital over a longer period frustrating or worse still meaningless.
Last reviewed 21 Dec 2007