These include:
- The Care Quality Commission, the main regulator for health and social care services
- Monitor which regulates NHS foundation trusts
- Individual professional regulatory bodies such as the General Medical Council, Nursing and Midwifery Council, General Dental Council and the Health Professions Council
- Other regulatory, audit and inspection bodies, some of which are related to healthcare and some are specific to the NHS.
In addition, there are extensive arrangements to manage and assess the quality of services provided by NHS trusts and their financial health.
Regulation of NHS services
Since April 2009 the Care Quality Commission (CQC) has been responsible for regulating the quality of health and adult social care services in England. Established under the Health and Social Care Act 2008, the CQC took over the functions of the Healthcare Commission, Commission for Social Care Inspection (CSCI) and the Mental Health Act Commission.
Registration
The Health and Social Care Act 2008 introduced a new system of registration that came into force from 1 April 2010. All providers of certain health and adult social care services, whether from the NHS or independent sector, have to register with the CQC in order to provide care. This requires them to demonstrate that they meet defined essential standards of quality and safety. See our Care Quality Commission registration web page for more information about how the NHS Confederation is supporting trusts.
Regulation of foundation trusts
NHS foundation trusts are also regulated by Monitor. Monitor authorises and regulates NHS foundation trusts to ensure they comply with their terms of authorisation. Its main focus is on financial performance and internal governance arrangements.
Regulation of healthcare staff
The professional regulatory bodies are responsible for regulating individual healthcare professionals. However, some requirements of the professional regulatory bodies also directly affect the organisations that employ them, such as NHS trusts.
Assessment of NHS services
Strategic health authorities are responsible for managing the performance of non-foundation NHS trusts in their area in relation to national targets and to financial control. Primary care trusts also have a role in monitoring the contracts they agree with trusts that provide NHS care.
Primary care trusts are subject to an annual assessment of their commissioning under World Class Commissioning.
From 2010, all NHS trusts (both providers and commissioners) will be subject to quality assessments by the CQC. This replaces the Annual Health Check previously undertaken by the CQC, and the Healthcare Commission, the predecessor organisation.
There are two main parts to the quality assessments:
- periodic reviews of the performance of all health and social care providers and commissioners, covering the quality of services provided and the organisation’s financial performance.
- special reviews and studies which look at issues in a particular area of care, often looking at the overall quality of service provided to patients by different providers across a patient pathway and the commissioning of those services.
The information gathered is published by the CQC to provide information and judgements about the quality of care. It also aims to make sure that those who buy or commission services are held to account for the quality and value for money of those services.
Other assessment and regulatory processes
In addition to the processes outlined above, NHS organisations are subject to oversight by many other statutory bodies and agencies. These include regulators such as the Health and Safety Executive and regulators with a specific health remit, such as the Medicines and Healthcare Products Regulatory Agency or the Human Fertilisation and Embryology Authority.
Other agencies are not regulators but also assess and monitor NHS performance, such as the NHS Litigation Authority and National Patient Safety Agency. Increasingly, NHS organisations seek external accreditation of their services.
Often the different regulatory and inspection regimes are duplicative. This creates significant and unnecessary burden on NHS bodies.
Confederation viewpoint
The NHS Confederation supports moves to create a lighter-touch regulatory framework that incentivises health bodies to improve service quality, and is risk-based and consistent with the principles of better regulation. However, we believe that more could be done to simplify the current system or regulation and assessment for the NHS, without jeopardising the quality of care for patients.
Creating a single regulator for health and social care should help to reduce some regulatory duplication and overlap, and ensure care is provided to consistent standards, whoever provides it. We particularly support the principle of registration based on activities and services provided, and welcome proposals to include primary medical and dental services within the scope of regulation.
The NHS Confederation meets regularly with the CQC to represent members' views and to influence the shape of the new system. We are particularly working to ensure that the new system does not unnecessary burden on providers.
To become involved in our regulation work programme, please contact frances.blunden@nhsconfed.org.