Should regulatory bodies the CQC and Monitor be merged into one regulator?

Robert Francis QC, chair of the Mid Staffordshire NHS Foundation Trust Inquiry

Dr Jennifer Dixon, Nuffield Trust

YES

Among the key recommendations from the Francis Inquiry into care failings at the Mid Staffordshire NHS Foundation Trust, published this week, is the proposal that England’s care sector regulator the Care Quality Commission (CGC), should be merged with Monitor, the body that authorises and regulates NHS foundation trusts.

The report revealed that over the course of the Inquiry, many people expressed alarm at the apparent failure of external organisations to detect any problems with the Trust’s performance. Robert Francis QC has recommended that the Department of Health commission an independent examination of these bodies in order to restore public confidence in the system and create a super regulator to scrutinise both clinical and financial standards.

He said: “Regulation would also be more effective if compliance with fundamental standards and requirements for clinical and corporate governance and finance control, were regulated by one organisation. The CQC should regulate all these matters together rather than responsibility being divided between CQC and Monitor.”

Mr Francis also wants the CQC to be given more powers to bring prosecutions as he said: “The CQC would also be expected to intervene where necessary to protect patients from non-compliance with the fundamental standards.”

He added: “We need to ensure fundamental standards are enforceable by law – and the criminal law in the most serious of cases. Senior managers should be made accountable, patients need to be protected from poor nursing standards and all staff should be empowered to be open and transparent when it comes to the well-being of the people in the care.”

NO

Nuffield Trust chief executive Dr Jennifer Dixon welcomed to the work undertaken by the Inquiry but announced caution at the proposal of a merger between the two bodies, commenting:

“There is much to commend in Robert Francis’s report and it is broadly in the right direction. The inquiry’s conclusions and recommendations must be considered in detail before we embark on ways to tackle the more systemic problems raised. “In particular, I would question the wisdom of merging the CQC and Monitor as it would bring further organisational upheaval at a time of huge financial challenge. There are more pressing priorities and structural remedies often don't deliver the solutions they set out to. The history of merging already large regulators is mixed at best and we should proceed cautiously.”

Martin Green, chief executive of the English Community Care Association (ECCA), commented that the effects on care providers themselves should be considered:

“We will want to carefully consider how other recommendations, for example around the strengthening of CQC; the proposed duty of candour; and the greater transparency of information, will impact on social care providers, whether commissioned by the NHS or not, in the spirit of learning from these shocking events in Mid Staffordshire.”

Toby Knightley-Day, managing director of Fr3dom Health, was also cautious on the regulation issue, saying:

“Strengthening regulation is not an answer on its own – more important is ensuring that involvement is taken seriously at all levels of health care. Only then will we stop the patient voice being relegated to a tick box exercise when its real purpose should be to help the NHS better understand its own behaviour and how this impacts on service quality.”