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The Quality Care Commission (QCC), the new independent regulator of health and social care in England, was only a couple of days old when introduced to the meeting by one of its commissioners Prof. Martin Marshall.

He began by outlining various types of regulation and their ways of improving patient care. One was professional: education and training, clinical audits, guidelines and peer reviews. Another was governmental: performance management and legislation. A third economic: incentives, sanctions, patient choice and competition. A fourth might be termed ‘industrial’ or organisation based. But with so many different agencies involved, he said, the field could become very cluttered and confusing.

The definition of regulation was sustained and focussed control through a system of rule making and adjudication carried out to assure the public that the regulated body was fit for purpose. “The days of saying ‘trust me I’m a doctor,’ are long gone,” he said. An increasingly knowledgeable public needed assurances, a balance between trust and checking.

Regulation must have the three components of direction setting, surveillance and enforcement and it must justify its £250m costs.

“It might sound cheesy to call the QCC a ‘people’s regulator’ but its primary interest group will be the users: patients and their families and carers. We will always take the user’s side in any conflict. Our independence is key. We’ll have big fights with government and with service providers if user interests need that.”

The new body is a merger of the Healthcare Commission, the Mental Health Act Commission and the Commission for Social Care. There had previously been a disconnection between these fields and their different approaches. It was as if healthcare was from Mars, social care from Venus. The former dealt with ill health, sick individuals, prescribing and institutions; the latter with well-being, the whole person, decisions and networks. But they needed to be part of the same continuum offering joined-up, personalised services and choice.

“This is a new way of looking at care,” added Prof. Marshall. “My mother who has had dementia for eight years has just gone into a care home so I have a close personal interest in this.”

The commission would also look at patient safety and quality of life. It would seek to involve expert groups and to carry out both formal and informal consultations with users, carers and providers. There would be emphasis on outcomes and value for money for the £250m budget. There was already a growing body of evidence that regulation did make an impact in focussed areas: the Healthcare Commission’s annual check in 2005 found that twice as many NHS trusts showed improvements as deteriorations; by 2008 the figure had increased to 20 times as many showing improvements.

The QCC would continue the trend towards self-assessment by service providers which would be checked by periodic reviews and targeted inspections. Whereas previous regulators had had few powers the new body could firstly name and shame with a public warning and follow that with financial penalties, suspension and closure. “We’ve no desire to be draconian and I suspect their use will be rare but they are there and will be used if necessary.”

Liz Gill
Freelance Journalist

BGS Newsletter, May 2009
Issue 21 ISSN 1748-6343 21