The inquiry found that the existing system for regulating the quality and safety of services resulted in overlapping functions. This allowed one regulator to assume that another held responsibility to ensure compliance, when that was not necessarily the case.
The inquiry therefore recommended that there should be a single regulator for all Trusts, to deal with corporate governance, financial competence, viability and compliance with patient safety and quality standards.
He also made recommendations on:
- who should hold responsibility for regulating and monitoring compliance with fundamental standards of care
- how information on compliance should be derived, for example from complaints, media coverage, patient safety alerts, quality and risk profiles
- how the sharing of information between regulators should be improved
The inquiry also made a series of recommendations to make the Care Quality Commission (CQC) more effective, like reviewing its processes to incorporate more of a patient perspective in its functions, and by adopting a clearer strategic vision. He also recommended zero tolerance of failures in quality of care.
In response to these recommendations, instead of transferring Monitor’s powers to the CQC, the government is putting in place a series of measures to ensure clearly defined responsibilities for the CQC, Monitor, and the NHS Trust Development Authority. This includes a new single failure regime.
Subject to the passage of new regulations, in 2014 the CQC will have new powers to prosecute a provider for failing to provide fundamental levels of care, without first having to issue a formal warning.
The government also plans to legislate on sanctions where individuals or organisations are unequivocally guilty of wilful or reckless neglect or mistreatment of patients. This will help ensure there is ultimate accountability for those guilty of the most extreme types of poor care.
At local and regional levels, Quality Surveillance Groups bring together commissioners, regulators, local Healthwatch representatives and other bodies on a regular basis to share information and intelligence about quality across the system, including the views of patients and the public.
Alongside the better use of information, these measures will bring about more decisive and prompt action on the part of the regulators where they identify the need to intervene in how a provider operates.
Recommendation 19Merger of system regulatory functions
Recommendation 20Policing fundamental standards
Recommendation 21Monitoring information accuracy
Recommendation 22Standard procedures and practice for compliance
Recommendation 23Formulation of standard procedures and practice
Recommendation 24Clarity over compliance with fundamental standards
Recommendation 25Developing measures of outcome
Recommendation 26Direct action over policies
Recommendation 27Promoting effective enforcement
Recommendation 28Zero tolerance of fundamental standards