Recommendation F19: Gaps between the understood functions of separate regulators

Not accepted, although we agree with the principle of a single regulatory process.
We agree with the principle that there should be a single regulatory process with clearly defined responsibilities across governance, finance and compliance with safety and quality standards. It is important that the system is able to identify and act quickly where there are potential risks to service users and, in ensuring this, that there are clear roles and responsibilities for all those involved in that process.
In Patients First and Foremost (2013) we stated that the Care Quality Commission, Monitor and the NHS Trust Development Authority would establish a single failure regime that would further clarify the separate functions of the Care Quality Commission and Monitor across health and social care. This will ensure that the role of inspecting Trusts is kept clearly separate from the responsibility for the turnaround of failing organisations, and there can be no conflict of interest in assessing quality. It also allows us to address, more fully, the Inquiry’s concerns regarding the potential impact on the whole system of rapid changes to the quality regulator.
The Care Bill lays the framework for a simple, flexible process for tackling quality failures in NHS Trusts and Foundation Trusts. It will remain the primary responsibility of the board of a Trust, working with their commissioners, to ensure the provision of good quality care.
The Care Quality Commission will not exercise its enforcement powers, beyond issuing a new warning notice outlined in the Care Bill, in respect to Trusts unless patients and service users are at immediate risk of harm, in which case it will be able to act immediately. Where intervention is required it will be the role of Monitor (for Foundation Trusts) and the NHS Trust Development Authority (for NHS trusts) to take action. Ultimately, if it proves impossible for an NHS Trust or Foundation Trust to turn their performance around, the organisation may be placed into Trust special administration on quality grounds. Special administration will provide a framework for determining how best to secure a comprehensive range of high quality services that are both financially and clinically sustainable. In very serious cases, the Care Quality Commission (subject to Parliamentary approval) will have the power to prosecute a provider for a breach of fundamental standards of care.
The Care Quality Commission, Monitor and the NHS Trust Development Authority will work together to publish further guidance on how they work together to address risks to quality. This will include details of how concerns, including immediate concerns, will be addressed; how and when special measures and the single failure regime could be triggered; and what guidance and support would be made available to the public in the event of large scale, significant failure. This guidance will build on the joint policy statement, The Regulation and oversight of NHS Trusts and Foundation Trusts (May 2013) published by the Care Quality Commission, Monitor, the NHS Trust Development Authority, NHS England and the Department of Health.