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New licence to care will act as a constant monitor


Regulation of the NHS is undergoing one of the biggest changes in its history. For the first time, NHS trusts have had to apply for what is, in effect, a licence to legally provide care to patients.

Over the past few weeks we have announced the results of those applications, with a minority of trusts having conditions placed on their registration where they have failed to show that they are meeting some of the essential standards of quality and safety.

Let me state quite clearly that one overriding aim drives the work of the Care Quality Commission: we intend to play our part in ensuring that people receive the best possible care.

‘We will be looking for clearly specified outcomes for patients, not just policies and processes. Patients’ views on their experiences will be central to our judgements’

I know this aspiration is nothing new to the nursing profession, and you may ask what difference the new approach to healthcare regulation will make.

The proof of the pudding will be in the eating, to use an old fashioned phrase.

The changes that we are responsible for implementing under the Health and Social Care Act 2008 are focused more than ever before on patient experience. And we will be looking at trusts’ performance today, not in the past.

The platform for achieving this is the new registration system, under which NHS trusts that provide services directly to the public have to be registered with the CQC from 1 April. Independent healthcare providers and adult social care services come under the new system on 1 October.

To be registered, all providers have to show that they are meeting essential standards of quality and safety. These standards are about things that matter to people, such as involving them in decisions about their care, treating them with respect, keeping clinical areas clean and ensuring services are safe.

We will be looking for clearly specified outcomes for patients, not just policies and processes. And patients’ views on their experiences will be central to our judgements on how trusts are performing.

We have registered all the NHS trusts. A relatively small number have had conditions placed on them, which means that they will have to demonstrate improvements in certain areas before we grant them “unconditional” registration. In the meantime, the spotlight is very much on them.

If we don’t see the necessary improvements, we have a new, stronger range of enforcement powers. We can levy fines, take court action or even suspend a service that a trust provides.

Registration will provide a continuous form of compliance monitoring for services rather than the retrospective annual assessment that the NHS has been subject to up to now. And we will carry out inspections whenever we feel it necessary to do so.

This new approach to monitoring compliance, together with closer working relationships with providers to improve care, will help us spot problems earlier than was previously possible.

The commission’s five year strategy is built around the same principles that are enshrined in the new registration system - namely, ensuring that care is centred on people’s needs, protects their safety and respects their rights to privacy, dignity and independence.

The nursing profession, along with healthcare as a whole, has undergone radical changes in the past 30 years. The nurse’s role has become more complex and has absorbed additional responsibilities. As the regulator, we recognise the crucial contribution that nurses make towards providing an efficient and effective healthcare system - and not only at the bedside.

I hardly need say that the essential standards of quality and safety that underpin the registration system should be incorporated into everyday practice. You can see these standards and more information about registration on our website at

Patients need to understand the choices available to them and that they are involved, as far as possible, in making decisions about their care. I’m in no doubt that the work of nurses is critical to achieving this. I’m sure nurses are also aware of the wider picture within their hospital, or care home, and their organisation as a whole.

Good relationships with staff in other departments and other organisations will help to ensure the smooth transfer of information about patients’ needs. Good administration and communication will aid the transfer of information and records when patients move between care settings, helping to provide good quality, joined up care.

There are other factors, of course, such as adequate staffing levels and training. If nurses see that something - anything - is not working properly, I would urge them to raise the matter within their organisation. Experience has shown that when poor practice goes unchallenged, it can lead to systemic failures and to more patients receiving poor care.

I want nurses to be in no doubt that we share their desire for patients to have the best possible care, and I would like to think that they will see the new approach to regulation as an important contribution to this end. I look forward to receiving feedback from the profession to help us to judge how well the system is working and how it might be fine tuned in the future.

Cynthia Bower is chief executive at the Care Quality Commission


Readers' comments (2)

  • Why are we not convinced? If the CQC did what they're supposed to do and arrive in NHS premises unannounced then I'd have a little faith that this is more than another paper exercise in collusion. How many quality quangos exist now and yet we have continuing state sponsored disasters and their cover up happening across the country.

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  • Hear hear to the above comment! The misalignment of rhetorical ideals, iterated by regulators, with the actual of what we all experience everyday in practice, is one of the factors discouraging HCW's from taking a more proactive approach in challenging poor standards. The fear that you will be seen as complicit in having allowed poor standards to continue unchallenged or, worse, the fear that exposing poor practice will lead to staff becoming a scape goat, offers a huge disincentive to taking on the strong arm of the system. Please CQC, nurses work hard to uphold standards, often under extreme pressures from management to 'put up and shut up'. Under these conditions, it's clear why nurses feel disempowered to continue every shift, every day, every week, every month repeating their same concerns. CQC, if you really want to improve standards, find a way for nurses to confidently bare witness, without fear of reprisal. Only then will you have the real power to make a change, in partnership with the dedicated people who deliver the service under extreme pressure.

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