NHS has relied too heavily on regulation to improve quality of care, conference is told

BMJ 2012; 345 doi: (Published 05 September 2012) Cite this as: BMJ 2012;345:e5968
  1. Ingrid Torjesen
  1. 1London

Frontline health professionals, not external regulators, are the key to driving up quality in the NHS, according to speakers at a King’s Fund meeting on Tuesday.

To date, the focus has been too much on patients and the forthcoming report into the crisis at Mid Staffs Hospital, which will be known as the Francis report, needs to enable NHS staff to deliver on quality, they said.

Anna Dixon, director of policy at the King’s Fund, told the meeting, which was called Quality first: are we expecting too much from the regulator? that there had been too much emphasis placed on the regulator and too great a tendency to blame the regulator when things went wrong. In fact there were three lines of defence for quality: the first line was frontline professionals, the second line boards and senior leaders, and the third the external regulatory structures.

“Frontline staff deal with patients and carers every day, they witness when things go wrong, but they are also the ones that have ideas about how the quality of care can be improved, so it is absolutely vital that they are empowered both to speak up and to act to be able to make changes in the services that can improve quality,” she said

Although organisations were ultimately accountable for quality of care and regulators responsible for assuring the public, it was “extremely difficult” for these bodies to know what is going on in individual health interactions.

Dixon said if the upcoming Francis inquiry report on lessons from Mid Staffs just focused attention on particular regulatory organisations “we will have missed an opportunity and perhaps missed the point.”

“It is really vital that the NHS moves away from a culture which is often rather too complicit in allowing poor care to take place,” she said. “One thing senior leaders can do is create a culture of openness—openness together with clear accountability and responsibility for staff.”

Cynthia Bower, former chief executive of the Care Quality Commission, said that revalidation was probably “one of the strongest drivers of quality that we have got now in the system” that should “empower, support and encourage” clinicians to report poor care and ensure that the care that they delivered themselves was the best it could be in a “culture of openness and appropriate challenge.”

Elizabeth Buggins, chair of the Birmingham Women’s NHS Foundation Trust, said the drivers of staff engagement were the same as those for high quality, good financial management, and high patient satisfaction

CQC staff surveys had demonstrated the importance of ensuring individual staff members and teams had clear objectives, and high levels of appraisal and training, she said. “We know that increases discretionary effort by well over a quarter [and] in some cases up to a third.”

Buggins hoped that the Francis report would focus on culture, the experience of staff and on removing staff who were not performing adequately rather than technical process.

“I would like to see Francis talk about how the NHS moves staff out who aren’t the right people much quicker because that is a big problem that we have with our professional regulators. They have been far too slow in supporting organisations to move staff who haven’t got the right attitude and don’t do the right things and don’t have the right skills.”


Cite this as: BMJ 2012;345:e5968