The Department of Health published Developing the NHS performance regime in June 2008. The document outlined plans to improve the transparency and consistency with regard to identifying poor performance, regulatory intervention and the management of failure.
The document outlined the complexity of dealing with the failure of state owned providers. The report stated that:
‘Last year’s Healthcare Commission report into the running of Maidstone and Tunbridge Wells hospitals provided a stark reminder, if one were needed, of the human cost of poor performance in the NHS.
To me, it emphasised more than ever the need for a systematic and transparent approach to managing performance across the NHS. This is precisely the goal of the new NHS Performance Regime: to consolidate and build on our current strong performance, while giving us the tools to intervene early to tackle the relatively few incidents of poor performance when they occur... The NHS Performance Regime is central to the system we are building, ensuring that we maintain consistent national standards even as we encourage more freedom and diversity among providers of care.’
The new performance regime would need to reflect the obligations placed on the government to provide service continuity and to protect state assets. In contrast, in circumstances where a private provider failed, the primary concern would be to maximise value to creditors. Any failure regime would need to be based on a requirement for:
- the local NHS to maintain provision during a period of transition
- the secretary of state to secure public assets
- local commissioners to be involved in discussions about service reconfiguration following a provider’s exit.
The department outlined its plans to work with stakeholders to create a failure regime and suggested that it would build on learning from the financial restructuring of failed public sector organisations.
The document also outlined the different roles of the Care Quality Commission (CQC) and Monitor.
The CQC would register health and social care providers, carry out periodic assessments of NHS providers and commissioners, carry out special reviews of services and pathways, and carry out investigations into specific organisations where safety was being compromised. Its principal role would relate to registration and providers would need to demonstrate that they could meet the essential levels of safety and quality required for continued registration.
In contrast, the principal role of Monitor would be to authorise NHS Foundation Trusts and then regulate trusts’ delivery against the terms of their authorisation. Monitor was able to intervene in order to ensure significant authorisation breaches were rectified or to act on third party findings. Monitor was required to establish and update the reporting and regulatory framework for Foundation Trusts. As part of its compliance framework, Monitor would undertake annual risk assessment and in-year monitoring. Monitor assigned risk ratings in three areas: governance, finance and ‘mandatory goods and services’ and used the risk ratings to guide the intensity of regulatory intervention.