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Looking back to look forward

Key lessons from system regulation of health and social care in England

31 March 2009
This briefing provides a rapid review of the lessons from published reports on health and social care system regulation. The aim is to summarise the key lessons, particularly relevant as a new integrated regulator begins its work on 1 April 2009, replacing the previous commissions. It also sets out what the RCN view is on system regulation, and what the RCN wishes to see as key priorities for the coming years. The RCN recognises that 2009-10 is a year of unprecedented change, but from 2010-11 onwards believes that there is a real opportunity to learn from the change experience to improve health and social care for the benefit of patients, carers, staff and the public at large.
The RCN has made clear in several recent Consultation responses and briefings the importance of system regulation. The RCN calls for a truly effective regulatory regime given the increase in providers involved in the delivery of health and social care. This includes sufficient levels of monitoring, investigation, and inspections, appropriate metrics and timely intervention by the regulator where quality is poor. This means a regulator with teeth. 

The RCN would also hope that the CQC will assess in a transparent manner its own approaches and be willing to adapt over time as appropriate. 

The RCN is also calling for ‘intelligent’ regulation. This means avoiding a box ticking approach but rather allowing for the use of professional judgement. It also requires investment in leadership by the CQC. This can be achieved by providing continuing training and support to assessors and inspectors and allowing standards to be measured through a mix of questions and indicators. The RCN recognises that this is a longer term agenda but hopes that it will be a focus of the first year of the new regulatory regime and going forward. 

The RCN also agrees with the very clear statement made by the HC that:

“The overall performance of the NHS in relation to safety of care has not changed in the last three years of the annual health check….This is for a set of standards that the Department of Health said should be met everywhere in 2004. But, this inadequate level of performance does not even get a mention in the Operating Framework for the NHS for 2009/10. It may be that the political pressures in the system are more concerned with certain specific targets which are readily measured than with the less easy to document, but fundamentally more important, general achievement of a set of standards for everyone”

The RCN therefore continues to work with all stakeholders on ways to ensure safe, high quality care.

The RCN also notes that this absolutely requires investment in leadership; not just at CQC, but within every organisation in the NHS and social care (from commissioners to providers). The HC has repeatedly documented the
importance of leadership and culture and appropriate staffing and training when it has investigated serious incidents. This is also backed up by various other evidence on the link between staffing levels, the role of nurses and patient outcomes. It is now well known that there need to be sufficient nurses, able to perform their role, to avoid negative impacts upon patients. This evidence of the link between these must not be ignored and the new integrated regulator has a real opportunity to champion long term sustainable safe and high quality care.

On the 30th March 2009 the Department of Health has opened a new consultation, A consultation on the framework for the registration of health and adult social care providers. This further sets out details on the registration
requirements of CQC. More details will be provided on the final arrangements as this becomes clear.

If you have any comments or wish to contribute further, please email policy.international@rcn.org.uk

Page last updated - 07/09/2015