National Health Service watchdog the Healthcare Commission has published a new report reflecting on its achievements over the last five years and the areas in need of focus going forward, as its time as regulator draws to a close.

The Commission will breathe its last breath at the end of this month when it passes the torch to a new integrated regulator - the Care Quality Commission - which will bring together regulation of the quality of health and adult social care for the first time.

According to the Commission, independent regulation of healthcare, which has really only taken off in the last decade, has helped to generate “significant progress” in improving health and care, playing a strong role in reducing premature deaths, protecting patients’ rights and boosting the overall quality of care.

On the down side, it admits areas in which progress has not been so strong include addressing the gorge of health inequalities still present in the UK today, patient safety, meeting the needs of vulnerable patients, and the priority given to protecting children.

The exact degree to which healthcare regulation has helped to drive service improvement is difficult to determine, as significantly larger cash streams into the NHS as well as extensive policy reform have played key roles. Nevertheless, the report claims “a range of robust evidence from evaluation work” exists to support the view that regulation has indeed made “an important contribution”.

Looking back on progress since its birth in 2005, the Commission says the proportion of NHS trusts rated as “excellent” or “good” climbed from 46% in 2005/6 to 60% in 2007/8, despite tougher assessments and inspections.

In addition, the ability of trusts to meet certain government targets – such as cutting waiting times for cancer treatment and the 18-week referral to treatment goal – has improved significantly since these were included in the Commission’s annual health check assessment, it says.

Health check benefits
The annual health check assessment is widely considered to have played a strong hand in driving service improvements in the last few years, with 93% of NHS trusts declaring a positive impact on patient care, and 81% claiming that the assessment helps to focus attention on patient safety, the report says.

Furthermore, the annual health check has identified and thus enabled further investigation of serious issues, thereby bringing about improvements in individual organisations and helping to boost patient safety and care, it stressed.

However, despite progress to date there is still much to be done in terms of continued service improvement and maintaining high levels of patient safety and care, and the watchdog has highlighted some common themes it feels the new regulator and the healthcare system as a whole must address.

“While overall levels of satisfaction are high, further progress is needed to ensure that patients really are at the centre of care,” it says, as “too many concerns about the standards of care arise because the culture of the organisation providing care does not consistently treat people with dignity and respect, protect them from harm and abuse, and promote their rights”.

Going forward, the report also stresses the need for: more attention on training staff and rewarding the right behaviour; ensuring that any patient/carer feedback – whether negative or positive - is acted on; measuring, benchmarking and reporting on performance; and ensuring that requirements for registration are patient focused.

Furthermore, it warns that problems will continue to arise where there is poor leadership and governance, as well as a lack of adequate information on outcomes of care. “In all of the Commission’s major investigations, the boards of the organisations were not receiving adequate information about the quality of care that their organisations were providing,” it explained.

According to the Commission, the creation of a new regulator of both health and adult social care “provides an opportunity to build on what has been achieved”, as well as an opportunity to take some new directions, by “ensuring better information on performance across the health and social care sectors, and promoting a more integrated approach to health and social care in meeting the needs of people using services”.

DH publishes regulation reports
Meanwhile, the Department of Health has published two new reports detailing improvements to the regulation of healthcare professionals.

The Tackling Concerns Nationally (TCN) and Tackling Concerns Locally (TCL) are aspects of wider government reforms on professional regulation, designed to raise the bar of professional standards and boost patient safety.

TCN includes proposals for the establishment of the Office of the Health Professions Adjudicator (OHPA) - an independent body tasked with assessing fitness to practise for healthcare professionals, while TCL sets out recommendations designed to tighten up local NHS procedures for identifying poor performance and taking effective action, according to the DH.

"Our overriding priority is to ensure that patients and the public are protected,” said Health Minister, Ben Bradshaw. “The recommendations outlined in Tackling Concerns Nationall and Tackling Concerns Locally will put in place the best systems, both locally and nationally, to identify and address concerns about individual professional conduct and competence,” he stressed.