Editorial

April 2010 saw the beginning of a new era in the regulation of healthcare in the UK, through the Care Quality Commission (CQC), which has been given new powers which will eventually cover the whole of health and social care. The new arrangements are being trumpeted by the current (at the time of writing) government as the answer to how tragic system failures such as Stafford, Maidstone & Tunbridge Wells and Basildon & Thurrock will be avoided in the future. However, it remains unclear as yet just how different and how robust the new system will be. Further uncertainty surrounds what might happen if the government changes, given the Conservatives' very different views of regulation and distaste in particular for the so-called ‘target culture’. Research conducted by AvMA suggests that more than just powers to regulate will be needed to make a real difference.

AvMA published its report ‘Adding insult to injury – NHS failure to implement patient safety alerts’ in February 2010. It received widespread media coverage. The findings, based on a Freedom of Information request to the Department of Health, revealed that over 300 NHS trusts (three-quarters of all trusts) were not compliant with at least one patient safety alert issued by the National Patient Safety Agency (NPSA), for which the deadline for implementation had already passed at the end of 2009. Eighty NHS trusts were not compliant with 10 or more alerts. There were over 200 incidences of alerts which were over five years old which had still not been complied with. Patient safety alerts are issued by the NPSA on issues where there is evidence that death or serious harm is being repeated and the risk can be significantly reduced by the implementation of ‘required actions’ contained in each alert. There is consultation with a range of experts and NHS providers before an alert is issued, and a realistic deadline for completion of the required actions is given. Complying with the alerts by the given deadline is a prominent ‘core standard’ laid down by the Department of Health which every NHS trust is required to declare that it meets as part of the ‘Annual Health Check’ exercise. (Until the new CQC regime kicks in, in April 2010, this system is the cornerstone of health provider regulation in England.)

Our research also found that while all the information on which trusts were overdue in complying with patient safety alerts was available to the CQC, to Strategic Health Authorities (SHAs), to the NPSA, and the Department of Health itself via its Central Alert System, there was no system in place for actually monitoring compliance or taking action over non-compliance. This finding was as shocking to us as the widespread non compliance with alerts themselves. One trust had not complied with 37 of the 53 alerts, but even this was not enough to set alarm bells ringing and spark any action, it would seem. Nor incidentally did the combination of this information with the fact the Trust had a higher than average mortality rate for several years running. Even with the trusts who had declared themselves compliant with alerts, there is no proper system in place for verifying that they actually were. In a small number of checks that the CQC did make, around 25% of the trusts had their declared compliance ‘qualified’.

The BBC ‘Panorama’ documentary broadcast on 8 March also picked on the ‘tick-box’ self assessment culture whereby even failing trusts such as Stafford could declare themselves compliant with ‘core standards’. There are huge challenges ahead for the CQC in regulating thousands of health and social care providers. It would be unrealistic to expect them to be ‘inside’ every NHS trust on a regular basis checking on everything. However, there needs to be a more proactive approach to chasing up trusts who are simply not playing ball and putting lives at unnecessary risk. Otherwise, what is the point in collecting the information in the first place? AvMA has presented its report, containing six recommendations for action to the Department of Health and eagerly awaits its response.