Introduction to the Care Quality Commission’s Regulation of Health and Social Care Providers

Since April 2010 the Care Quality Commission has gradually introduced legal requirements for a number of organisations, in relation to the provision of health, adult social care and dental services. These requirements relate to all providers of a regulated service as defined by the Health and Social Care Act 2008.

The Care Quality Commission has developed a document detailing the Essential Standards of Quality and Safety that they have identified providers should be meeting in order to be delivering services in a safe and patient focused way. These essential standards replace the previous guidance provided in the form of The Standards for Better Health for NHS Trusts and the previous regulations under the Care Standards Act 2000.

Under the CQC’s new system, the intention is that all registered providers will be demonstrating the same set of essential standards of quality and safety whilst also demonstrating respect for their service users’ dignity and rights. This uniform set of standards applies across the board, whether providing community based healthcare, domiciliary care within the home or long term residential nursing care. The focus of this new registration system is the assessment of outcomes from the point of view of the patient or service user.

This means that providers will need to be able to demonstrate that their patients are happy with the services that they are receiving and that they have proactively consulted with them in designing and re-designing their provision. This patient focused approach thus demonstrates a slightly different approach to the previous regulatory body, who were more targeted towards the implementation of robust policies and procedures. Further differences can be seen in the fact that providers will need to be registered for each regulated activity that they carry out rather than as an organisation as a whole; the regulated activities that require registration are listed below:

– Personal Care
– Accommodation for people who require nursing or personal care
– Accommodation for people who require treatment for substance misuse
– Accommodation and nursing or personal care in the further education sector
– Treatment of disease, disorder or injury
– Assessment of medical treatment for people detained under the Mental Health Act 1983
– Surgical procedures
– Diagnostic and screening procedures
– Management of supply of blood and blood derived products
– Transport services, triage and medical advice provided remotely
– Maternity and midwifery services
– Termination of pregnancies
– Services in slimming clinics
– Nursing care
– Family planning services

With such a broad spectrum of activities that need to be registered it is hoped that this new system of registration will ensure that services are being provided in line with service users’ needs and that patients can expect a uniform approach to the care and treatment that they receive regardless of when or where it is delivered. Additionally, with details of registrations being made available on the Care Quality Commission’s website it will be possible for the general public to assess a service’s registration status and compare it with alternative options, thus providing choice and an incentive for providers to maintain and/ or improve standards.

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What Is the Health and Social Care Bill?

On the 19th January 2011, Parliament introduced the health and social care bill 2011, which brings with it a new direction for the NHS. The intention of this Bill is that it will modernise the NHS and work towards the government’s vision of the National Health Service being developed around patients, led by health professionals and delivering world class outcomes.

The ultimate aim is that with restructuring and re-focusing the NHS it will prove itself on a world class scale as one of the leading health care systems in existence.

The Bill itself builds upon and develops the papers produced in 2010; Equity and Excellence – Liberating the NHS (July 2010) and Liberating the NHS: Legislative Framework and Next Steps (Dec 2010). Both of these documents were the initial backdrop to this latest Bill which has been developed to cover five key themes. These themes are:

• strengthening commissioning of NHS services
• increasing democratic accountability and public voice
• liberating provision of NHS services
• strengthening public health services
• reforming health and care arm’s-length bodies.

But what exactly does all that mean? Well it is hoped that this Bill will allow for the costs of administrating the NHS to be decreased and through careful commissioning, the element of patient choice will be increased, with both of these goals being achieved under the governance of an independent NHS Board. This board will provide direction to and for commissioners to ensure that resources are allocated efficiently and appropriately.

In addition, the regulatory bodies currently involved with Health and Social Care services will also have more influence over service providers with the Care Quality Commission’s current remit and powers strengthened and Monitor, the organisation that regulates NHS Foundation Trusts, being transformed into an economic regulator to ensure that fair competition and accessibility is evident throughout the NHS. One of the ways in which the Bill proposes to cut administration costs is to totally abolish all Primary Care Trusts and Strategic Health Authorities – this particular proposal is proving to be a very controversial decision, with job uncertainty currently rife within the NHS and Trusts currently unable to make any commitments with any sense of certainty.

So how close are we to the Bill being passed and these proposals being put into practice? Well, after its initial presentation to Parliament in mid-January the key elements of the Bill were then debated in the House of Commons at the end of January. Following this debate it was then agreed that it should be given a second reading and it was therefore forwarded to a Public Bill Committee to obtain their opinion, with oral and written evidence being provided.

The Bill is still under scrutiny with third, fourth and fifth sittings of the committee having already been carried out, and there is still a long way to go before the Bill is fully implemented. The next steps are for it to be passed through the House of Lords before any amendments are considered, following this it will then move on to be approved by royal assent, when it will finally be implemented in full.

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