Key points
- The Care Quality Commission (CQC) was created in 2009 through a merger of the Healthcare Commission, the Mental Health Commission and the Care Service Inspection Service. Its principal role is to register all health care providers, and it has the power to deregister a service if standards of care are persistently low. However, it will continue to provide annual reports to parliament on the state of health care (and adult social care) and conduct special reviews or investigations.
- Strategic health authorities are the regional arm of the Department of Health. They are responsible for managing the performance of NHS organisations in their area in relation to national targets and to financial control.
- Primary care trusts purchase services from NHS and other providers on behalf of their residents. The contracts they agree are, at least in principle, legally binding. As a result they are the ‘front line’ in monitoring provider performance.
- There are nine professional regulators, most of them for individual professions, such as the General Medical Council and the Nursing and Midwifery Council. A number of smaller professions are regulated by the Health Professions Council. All these regulators are in turn regulated by the Council for Healthcare Regulatory Excellence.
- The National Audit Office is parliament’s own watchdog. It reports to the Public Accounts Committee of the House of Commons. The Committee issues reports on the basis of the NAO’s findings. The government is bound to make a formal response to their findings.
- Monitor is the regulator of foundation trusts. Its main focus is on financial performance and internal governance arrangements. In the event of any serious failure, actual or forecast, Monitor can intervene in the management of the trust concerned to ensure that performance improves.
- Standards of clinical services are governed by a wide range of initiatives, most significantly the publication of national service frameworks for a number of conditions. Up to now there have not been comprehensive standards for the full range of services the NHS provides. The Next Stage Review, published in June 2008, proposed that NICE should be tasked with developing a set of standards to cover all clinical services.
- Systematic arrangements for monitoring performance have been put in place gradually over the past four decades. The main historical milestones are as follows:
- The Hospital Advisory Service (later renamed the Health Advisory Service) was established in 1969 following an investigation into conditions at Ely Hospital and other similar institutions. Its role was to support local management in improving the management of patient care and to advise the Secretary of State on conditions in hospitals. In 1983 the HAS was subsumed into the Mental Health Commission.
- The Parliamentary Ombudsman was established by the Parliamentary Commissioner Act 1967. A Health Service Ombudsman was created in 1973, and the two roles were merged. The Ombudsman’s role is to undertake independent investigations into complaints that public bodies, including the NHS, have not acted fairly or have provided a poor service.
- The Clinical Standards Advisory Group was established in 1991 in response to the medical profession’s concerns that the introduction of competition following the 1990 NHS and Community Care Act would put clinical standards at risk. Its function was to advise on standards of clinical care in the NHS and on access to and availability of services to NHS patients. It role was subsequently subsumed into that of the Commission for Health Improvement.
- The Commission for Health Improvement was established in 2000, initially to monitor clinical governance. It went on to develop a system of star ratings for NHS trusts. This was merged into the Commission for Healthcare Audit and Inspection – always known as the Healthcare Commission – in 2002. The Healthcare Commission was accountable direct to Parliament, not through the Department of Health, and its board appointments were made by the Appointments Commission.
