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Healthcare Commission slams proposed merger with two other NHS inspectorates

BMJ 2008; 336 doi: https://doi.org/10.1136/bmj.39461.545694.4E (Published 17 January 2008) Cite this as: BMJ 2008;336:117
  1. Rebecca Coombes
  1. 1London

    An “unnecessary” £140m (€184m; $274m) shake-up of healthcare regulation in England will threaten patient safety, the chairman of the NHS healthcare inspectorate told MPs last week.

    Professor Sir Ian Kennedy, who chairs the Healthcare Commission, said that merging his organisation with the social care and mental health inspectorates in a “bonfire of the regulators” was a hugely misjudged plan that would dent confidence in regulation among patients, clinicians, and NHS leaders.

    In his speech to the Labour Party conference last year, Prime Minister Gordon Brown said that a stronger regulator was needed to quell public concern about healthcare acquired infections.

    But the proposed merger under the Health and Social Care Bill was a costly mistake, claimed Professor Kennedy. “The policy will, at a critical stage, set back the development of a culture of safety,” he said, saying that staff would become distracted by the upheaval, instead of meeting the accelerating demands and expectations of patients.

    In a frank memo to MPs on the Public Bill Committee, who are considering the legislation, Professor Kennedy said: “I am not interested in protecting any particular organisation. But abolishing three organisations and creating a new one is a major undertaking. It inevitably means expense and distraction.”

    He said the move could not be justified on grounds of efficiency because the commission had already cut costs by 30% in two years. If the merger was intended to strengthen the regulation of health care for patients’ safety, then that aim would fail.

    He said the commission had gained real momentum in the drive to improve quality and safety—for example, with work on maternity services, health care for people with learning disabilities, and infection control. He doubted the need for greater powers over NHS organisations.

    The proposed legislation would give the commission powers it neither sought nor desired, he said.

    “While there are calls on all sides of the House [of Commons] for greater regulatory powers―such as fines or powers of closure―it is not at all clear that [these] powers are needed. The Healthcare Commission already has a battery of powers, which it has used to good effect,” he said.

    He continued: “It has never felt it could not preserve or protect the interests of patients through lack of powers. Some of the mooted powers seem inappropriate for a regulator―no regulator should contemplate as a solution to the needs of patients and staff, the immediate closing down of some NHS service.”

    Putting the regulation of health and social care together in a single framework was “desirable,” but putting them in one organisation was not the answer. “Structural changes do not, of themselves, achieve what plain old working together has already achieved,” he said.

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