Shoehorning three into one

When Barbara Young was asked to chair the new Care Quality Commission, she might have expected the toughest part of the job would be uniting three different regulators: the Healthcare Commission, the Commission for Social Care Inspection, and the Mental Health Act Commission. But last week’s report into care at Mid-Staffordshire NHS Foundation Trust (BMJ 2009;338:b1141, doi:10.1136/bmj.b1141) shows that much more than that needs to be done and raises questions about the whole structure of regulation she has inherited.

Mid-Staffordshire was deemed “fair” by the Healthcare Commission in 2006-7 and “good” in 2007-8—but “appalling” last week, after the commission had carried out a detailed investigation prompted by patients’ complaints. This was a trust that was considered good enough to be awarded foundation status by Monitor, the regulator of foundation trusts, in apparent ignorance that it was already under investigation by the commission; and a trust that was defended from criticism by the regional strategic health authority, NHS West Midlands, whose chief executive, Cynthia Bower, had been hand picked by Baroness Young to be her chief executive at the new commission.

All in all, hardly a textbook example of good regulation or joined-up thinking. So is now a good moment to be undertaking a major reorganisation that was heavily criticised last year on its passage through the House of Lords as pointless and misconceived? Baroness Young defends it stoutly but rather gives the game away by insisting that …