Care Quality Commission Could Make SHAs Redundant

The NHS Confederation has called for a major rethink of strategic health authorities’ roles in light of the new regulatory regime.

Senior policy manager Frances Blunden said the massive powers wielded by the Care Quality Commission from April will increase duplication between SHAs and regulators.

She told HSJ: “There are increasingly strong concerns from providers about what they’re being asked for from SHAs and a strong sense that it’s duplicating the regulatory approach. Under the CQC, there would be a much stronger regulatory regime. If we have the CQC, and that becomes robust… one has to question why we need the SHA role.”

Her comments come as the CQC reviews its proposed enforcement powers, which include fining trusts and closing services.

In 2009-10, the powers will only apply to NHS providers in relation to healthcare associated infections. From April 2010, all health and adult social care providers will be subject to the full range of powers.

The confederation’s response to the CQC’s consultation, which closed last Friday, welcomes the regime as being potentially more proportionate than the current system.

But it questions whether persistent non-compliance with minor regulations should automatically be seen as indicating a high risk for patients.

When deciding to undertake an investigation, the CQC should publicly explain its rationale for doing so, it says.

The confederation’s Foundation Trust Network has used its separate consultation response to call for clarification on when the new powers will be used and how any overlaps with Monitor will be avoided.

The CQC’s examples of situations that might lead to service closure were “hugely disproportionate” and could lead to “large swathes of the NHS” being closed to patients during infection outbreaks, it said.

The network also said sanctions ignored the size and income of an organisation, meaning fines “might not have any significant impact” on larger ones but could be “unnecessarily punitive” to smaller ones.

The CQC is expected to publish a formal response in March.

NHS North West chief executive Mike Farrar said SHAs and the CQC both had valuable roles. “There is a material difference between the responsibility of SHAs to help support the development of world class commissioning and an objective independent assessment of progress by a regulator,” he said.

HSJ’s Patient Safety Congress 2009 is on 30 April.