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New legislation ushers in range of health and social care reforms

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The Health and Social Care Bill had its second reading in the Commons last week, Emma Vere-Jones considers its implications.

The Health and Social Care Bill is a huge piece of legislation, bringing together many disparate issues that will impact both on nurses as individuals and on the organisations for which they work.

The bill includes a range of reforms to professional regulation. For nurses the most immediate change will be to NMC fitness to practise hearings. The regulator will in
future require a lower standard of proof to discipline registrants.

The move from a criminal standard of proof to a civil standard of proof means that rather than having to prove ‘beyond all reasonable doubt’ that a nurse is guilty, the regulator will in future only have to prove a case on the ‘balance of probabilities’.

The NMC argues that the impact of the change will be minimal because it plans to introduce a sliding scale, which will mean that more serious cases will still require a higher standard of proof than less serious cases.

But nursing unions are cautious about this system’s reliability and fear that lowering the standard of proof could still see an increase in the number of cases going before the regulator.

‘When it comes to someone’s livelihood, we would argue that the strongest possible [standard] should be used,’ said Gail Adams, Unison’s head of nursing.

‘If you’re going to use a lower threshold then it’s likely there’ll be an increase in cases, which means the cost [of fitness to practise hearings] will increase and potentially we could again have a backlog of cases.’

Another issue is a provision within the legislation for mandatory sharing of concerns about health or fitness to practise between any designated bodies. Unions fear that this could see nurses effectively prevented from working based on advice that may not be fair or accurate. ‘In effect it could legitimise blacklisting,’ said RCN policy adviser Jane Naish.

The bill also outlines in more detail the formation of the Care Quality Commission (CQC), the new super-regulator that will replace the Healthcare Commission, the Commission for Social Care Inspection and the Mental Health Act Commission.

The CQC will assess health and social care organisations in both the public and private sectors. But some have voiced concerns that such a monolithic structure may not function as effectively as its predecessors.

‘It’s a massive undertaking to merge three such different organisations – it just feels
like they’ve underestimated the extent of the challenge,’ said RCN policy adviser Tim Curry.

The new organisation will have greater powers than its predecessors, with the ability to fine organisations and close wards, and even hospitals, where it deems necessary.

But there is concern about a provision in the legislation that allows the health secretary to order inquiries and investigations by the CQC to be kept ‘private’.

Other sections of the bill include changes to the collection and dissemination of child weight data, providing pregnant women with cash grants in the final stages of pregnancy and updates to legislation on preventing the spread of infectious diseases (NT News, 27 November, p5).

While the bill could still change as it progresses through parliament, it has so far met with surprisingly little resistance from opposition MPs. It is expected to pass into statute in the middle of next year.

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