More regulation is not the answer to poor care, ministers are told

BMJ 2012; 345 doi: (Published 19 November 2012) Cite this as: BMJ 2012;345:e7864
  1. Matthew Limb
  1. 1London

Leading NHS figures have urged the government not to burden the health service with more regulation in response to the Mid Staffordshire care scandal.

Frances Blunden, senior policy manager at the NHS Confederation, which represents most NHS organisations, said she was “deeply concerned” that ministers might “get hold of regulation as the solution” and that this could inadvertently harm the quality of care.

She said, “Changing regulation is disruptive and costs money. We need to be conscious of that in the current financial situation.”

Blunden said that the regulatory regime was “too remote” and that responsibility for improving quality had to rest with NHS organisations themselves, which needed to be more open with patients and staff.

She was speaking at a conference, “NHS quality of care—delivering sustainable improvement,” held in London on 15 November by Public Service Events.

Jeremy Taylor, chief executive of National Voices, a coalition of charities representing patients and service users, endorsed this view, saying, “We don’t need more regulation. We don’t need to regulate managers, and we don’t need to regulate healthcare assistants.”

He repeated the charities’ call for a new “statutory duty of candour”1 to combat secrecy in the NHS and said that there should be a national drive to improve the quality of primary care.

Publication of the final report of the public inquiry into the serious failings and neglect of patients at Mid Staffordshire NHS Foundation Trust has been deferred until January 2013.

Conference participants discussed what more could be done throughout the NHS to raise the quality of care and to hold poorly performing NHS organisations to account.

Several speakers said that trusts and clinical commissioning groups had to go further in promoting a culture of openness, so that staff members, patients, and patients’ families could raise concerns and be assured that they would be listened to.

Evidence showed that trusts with a positive reporting culture, that promoted continual feedback, and that encouraged complaints were those with a good patient safety record, Blunden said.

Peter Carter, head of the Royal College of Nursing and a former trust chief executive, said that managers should always “walk the job” and speak regularly to staff, patients, and visitors.

David Black, director of postgraduate medical and dental education for the Kent, Surrey and Sussex deanery, said that more engagement with trainees was needed. “They are a highly idealistic and very intelligent workforce—don’t ignore them,” he told the conference.

The health minister Earl Howe insisted that the quality of NHS care was not suffering because of the drive to deliver efficiencies. The minister, who has a lead role on quality, hailed the £5.8bn (€7.2bn; $9.2bn) of efficiency savings made by the NHS in the past financial year as a “significant achievement” and said that progress was continuing.

Money saved from local initiatives such as those in kidney, stroke, and alcohol services was being reinvested effectively, he said. “Performance is being maintained and improved,” he added. He said that he recognised that continuing to improve quality and deliver efficiency savings was a “substantial challenge,” and he praised NHS staff for the “extraordinary” job they were doing.

The minister said that the newly published NHS Mandate would be a catalyst for “driving quality throughout the system” by encouraging changes in culture and behaviour.2


Cite this as: BMJ 2012;345:e7864