Editorial

As this goes to press we are at the dawn of significant changes to the system of healthcare regulation in England. The changes come at a time of dramatic and worrying revelation of the NHS's capacity to fail quite spectacularly and tragically. In the space of one week in March, we had the report on Mid Staffordshire NHS Trust, Birmingham Children's Hospital; substandard care of people with learning disabilities; and the start of inquests into deaths at Gosport War Memorial Hospital (although these occurred 10 years ago). In April, the responsibility for regulating health and social care was transferred to a new body – the Care Quality Commission – and a new complaints procedure was introduced for NHS and social care. In March, the final reports of Department of Health convened groups making recommendations for implementing the reforms to health professional regulation were finally published. This seems a good time to take stock.

I, like many of our readers I suspect, was not only greatly saddened but extremely angry that it was possible that the appalling standards of care at Staffordshire Hospital were allowed to go unchecked for so long, with the resultant human cost. The Healthcare Commission is to be commended for its ability to conduct robust investigations and its willingness to not pull any punches. However, surely it is time that our systems of regulation prevented these scandals rather than just exposing them? What confidence should we have that the system overseen by the new Care Quality Commission will be any more capable of achieving this? On first sight it will continue to still be largely based on self-assessment. And what of the role of Monitor and the concept of Foundation Trust status? While politicians sought to pin the blame solely on the management of the Trust itself, it seems clear that serious questions need to be asked about a system which failed to spot the problems and intervene, and where bodies such as the Healthcare Commission and Monitor do not even know what each other are doing. The fact that this Trust was awarded Foundation Trust status says it all. If anyone was under the impression that ‘Foundation status’ was a mark of quality in any sense that patients would recognize, they must now be having second thoughts.

One of the most depressing things about the Staffordshire affair from AvMA's point of view is that once again it demonstrated how the voice of patients too often goes unheard. Patients and their families had to fight hard to get authorities to realize that there were serious problems. It should not be such a struggle. Perhaps problems would have risen to the surface earlier if the Government had not destroyed local systems of patient empowerment in monitoring the NHS by abolishing Community Health Councils? What is evident is that the new confusing systems of LINks, ICAS, PALS, et cetera, need to be made robust enough to give patients a strong voice. There needs to be an ability for the Ombudsman to recognize patterns and spark action from the Care Quality Commission, now that the new body will not benefit from intelligence from the independent review stage of the NHS complaints procedure as the Healthcare Commission did. It also needs to be made much clearer exactly how individual members of the public can take their serious concerns direct to the Care Quality Commission rather than hoping that the NHS's own complaints system will somehow meet that need.

The April changes do provide some cause for optimism that things will change for the better. The potential is there. The NHS Complaints procedure has been improved. We have a new Care Quality Commission which can still be influenced to address the shortcomings of the past and the recommendations for reform of health professional regulation give some hope that there will be improvement there. However, while such serious questions remain about the old system that allowed Staffordshire to happen, the case for a public inquiry into what went wrong at every level is irresistible.