Final Report > Chapter 24: A Health Service which is Well Led > The future framework for the regulation of the quality of healthcare

The future framework for the regulation of the quality of healthcare

34 We turn now to the second of the two fundamental elements required for a well-led NHS: regulation. First, we need to make clear what we mean by regulation. It is a broad term. It describes all those processes by which the safety and quality of healthcare are assured. It can be divided into two categories: the regulation of healthcare professionals and the regulation of healthcare institutions (hospital trusts, health authorities and primary care groups/trusts). The regulation of healthcare professionals, historically largely associated only with discipline, involves all matters affecting the performance of the professional. It covers, therefore, initial education, training, appraisal, continuing professional development and, where relevant, disciplinary action. The regulation of institutions is equally broad, addressing those systems which set, monitor and enforce standards and disseminate information on performance. This approach to regulation allows us to capture the whole varied range of activities which are concerned with safety and quality under one heading. What is currently a mass of ill- or uncoordinated activities can be reanalysed once it is recognised that they are part of a common process.

35 Once regulation has been properly defined, we need to ask who is going to be responsible for the two categories of regulation which we have identified. We begin with our conclusion. Regulation, as we have defined it, is not properly a task for central government, through the DoH. As a monopoly provider, it cannot be in the public interest for it also to set and monitor the required standards of performance. Its role must be to ensure that the standards of care once established are delivered. In our view, regulation must reside in bodies which are not directly under the control of government. The role of the Department should be to create the necessary regulatory framework and then stand back, only becoming involved when significant changes in the policy of regulation are involved.

36 As regards the regulation of institutions, we have noted that government, through the creation of bodies such as NICE and CHI, has gone some way to creating the sort of system which we regard as essential. [13] But two further steps are required. First, these bodies must be given greater autonomy and independence from central government's control. Second, there must be some overarching body which can integrate and co-ordinate the activities of all the various individual bodies concerned with safety and quality. Only if such a body exists will the risk which we identified in Bristol be avoided: the fragmentation of responsibility among a plethora of organisations and the danger that concerns fell through the cracks between organisations. This overarching body must be created by government to be at arm's-length from and independent of government. It could be called the Council for the Quality of Healthcare. We point out that this is the only new body which we recommend should be created. All the other bodies to which we refer already exist or are proposed in `The NHS Plan'.

37 We adopt the same approach as regards the other area of regulation, that of healthcare professionals. Currently, there are a large number of bodies involved in the activities which together constitute regulation. They include the new Nursing and Midwifery Council, the GMC, the proposed new body which will regulate the professions allied to medicine, the Royal Colleges, the various professional associations, the DoH, health authorities and trusts. Each operates in its own sphere, with, historically, little collaboration or co-operation. The various activities must be brought together and properly co-ordinated. The role of the various bodies must be clearly identified. And all of the bodies should be brought under the overall leadership of one overarching body. This body in turn must be independent of the DoH. It could be called the Council for the Regulation of Healthcare Professionals. (In effect this is the body currently proposed in `The NHS Plan', referred to there as the Council of Healthcare Regulators.)

Footnotes

[13] We note, however, the current difference in status of these bodies. NICE is a Special Health Authority of the NHS; CHI on the other hand is not part of the NHS but is a non-departmental public body allied to the DoH