Education And Debate

The rise of regulation in the NHS

BMJ 2002; 324 doi: https://doi.org/10.1136/bmj.324.7343.967 (Published 20 April 2002) Cite this as: BMJ 2002;324:967
  1. Kieran Walshe, Harkness fellow in health policy (kieran.walshe@man.ac.uk)
  1. University of California, Berkeley, CA 94720, USA
  1. Correspondence to: K Walshe, Manchester Centre for Healthcare Management, University of Manchester, Manchester M13 9PL
  • Accepted 20 September 2001

The current British government has created five national agencies to regulate the NHS. These new arrivals are simply additions to an already crowded regulatory landscape. But, if politicians can be persuaded to let go, the new regulators of the NHS could provide a genuinely new approach to improving performance and management

During the past four years the British government has created five new national agencies to regulate the NHS in England (box).1 2 3 4 The government has moved away from using markets, competition, and contracting to manage performance in the NHS. But it has been unwilling to rely on traditional bureaucratic structures to exert control, and has turned increasingly to regulation.

In this article, I describe how and why organisational regulation in the NHS in England has grown in recent years. I examine how regulation was used in the NHS in the past and describe the characteristics of the new regulatory agencies. Finally, I use information from the wider literature on regulation to examine the regulatory model adopted by these new agencies and to explore what they might learn from regulation in other settings.

Summary points

Over the past 20 years, regulation has increased in Britain's private and public sectors

In the past four years the British government has created five new national agencies to regulate the NHS

The new agencies could be the start of a new approach to improving performance and management in the NHS

The new agencies could learn from regulators in other sectors and adopt a responsive approach to regulation

New national agencies to regulate the NHS

National Institute for Clinical Excellence

Commission for Health Improvement

Modernisation Agency

National Patient Safety Agency

National Clinical Assessment Authority

Defining regulation

Regulation is “sustained and focused control exercised by a public agency over activities which are valued by a community.”5 The key features of regulation are that …

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