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by GK Strategy 13th June, 2016

Regulation: help or hindrance?

The Care Quality Commission (CQC), the primary regulator of quality in the healthcare system, is now seven years old. It has been a turbulent existence so far, not least with quality failings in scandals such as Winterbourne View and Morecambe Bay. It has already undergone a great deal of reform and has recently introduced a radically different approach to inspecting health and social care providers. Nonetheless, some have argued that it has failed to adequately tackle quality failings in the NHS, with the majority of hospitals requiring improvements in quality according to their latest inspection reports. With budget cuts imminent, there is now a wider question over the nature of regulation in the healthcare sector as a whole.

A substantial challenge is how the CQC can utilise their inspections to drive system-wide change and with many in the healthcare system considering their inspections to be superficial at best, but often distracting and demoralising, there is an urgent need for the regulator to communicate a more constructive role for itself. At present it has all too often been dragged into the debate over the “culture of fear” that continues to pervade the NHS and it has found itself caught between Government and providers with the stipulation that the CQC is to fully recover the chargeable costs of regulation.

Linked to this point on fees is the recent publication of their new strategy for 2016 to 2021, titled ‘Shaping the Future’, which in the CQC’s words “will undoubtedly influence the costs of regulation”. One of the four key priorities outlined in the strategy, to “promote a single shared view of quality”, is perhaps the most striking. This process should incorporate the views of providers and service users, an often attempted project in the NHS. There’s a risk, however, that this will merely increase spending on ‘soft’ regulatory activities, with the cost passed on to hard pressed providers, without much discernible improvement in care quality or outcomes.

In the context of a rapidly changing health system stemming from the Five Year Forward View and punctuated by new models of care and the developing Sustainability and Transformation Plans, the CQC is grappling with how to pursue a regulatory regime that sufficiently accounts for place based health economies. Quite how they will do this, and whether they will be successful, remains unclear.

A further point of significance within the new strategy is that the CQC will take a more targeted and tailored approach to planning inspections which will more adequately reflect where the risks lie, which perhaps reflects an attempt to avoid becoming an adversarial regulator like Ofsted.

All of this begs the question of what the CQC’s role will be in the future and whether it is desirable or necessary to have separate regulatory regimes for quality and financial stability for the NHS. With a new strategy and inspection framework providers will need to be mindful of the new approach but ultimately it will be up to the Government whether the CQC’s work is leveraged into a broader process of longer term quality improvement and financial stability.

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