Recommendation 64

Merger of system regulatory functions

Rejected
The authorisation process should be conducted by one regulator, which should be equipped with the relevant powers and expertise to undertake this effectively. With due regard to protecting the public from the adverse consequences inherent to any reorganisation, the regulation of the authorisation process and compliance with Foundation Trust standards should be transferred to the Care Quality Commission, which should incorporate the relevant departments of Monitor.

As outlined in relation to recommendation 19, We agree with the principle of better regulation of the authorisation process, we do not intend to merge regulatory functions. What is needed is radically better coordination between the regulators, and a far stronger focus on the quality and safety of services within the authorisation process, than was the case at Mid Staffordshire NHS Trust.

The Department of Health, with the Care Quality Commission’s chief inspectors, is currently developing fundamental standards and will consult on setting these out in regulations, which make clear the standards below which care should never fall. A provider who is in breach of fundamental standards should not be authorised as a foundation trust.

As set out in recommendation 20, the Care Quality Commission’s new approach to inspection will look more broadly than just compliance with regulations. It will reach judgements about the overall quality of services, taking into account how safe, effective, caring, responsive and well-led they are. No provider will be authorised as a foundation trust unless the Care Quality Commission, through its Chief Inspector of Hospitals, judges that the quality of their services is ‘good’ or ‘outstanding’.

The NHS Trust Development Authority, Monitor and the Care Quality Commission have undertaken an end-to-end review of the foundation trust assessment and authorisation process. The review aligns Monitor’s Quality Governance Framework with the Care Quality Commission’s approach to assessing leadership, culture and governance as part of the new inspection methodology. Monitor, the NHS Trust Development Authority and the Care Quality Commission will also develop a common set of quality indicators. This should ensure that there is a seemless process at every stage of assessment.

Update

The NHS Trust Development Authority, Monitor and the Care Quality Commission published How Monitor, the Care Quality Commission and the NHS Trust Development Authority will work together to assess how well led organisations are in May 2014.

The metrics by which the NHS Trust Development Authority will assess the quality of services delivered by any given Trusts, which are set out in the NHS Trust Development Authority Accountability Framework for NHS Trusts, are consistent with those used by the Care Quality Commission in its Intelligent Monitoring system.