In November 2006, the Department of Health launched a consultation on bringing together the regulation of NHS and adult social care services following the 2005 Budget announcement that the government would bring forward proposals to merge the Healthcare Commission and the Commission for Social Care Inspection.
Prior to the publication of The future regulation of health and adult social care in England the Department of Health had conducted a wider regulatory review on the health and social care system. The review had found that regulation should act as an incentive to better self-regulation, and that system management and regulation should take into account the need to tackle health inequalities. In addition, the review found that system management should consider broader value for money issues on a community rather than organisational basis. Concerning this approach, the report stated:
‘In all public services, we are making a radical shift from top-down, target-driven performance management to a more bottom-up, self-improving system built around the individual needs of service users and influenced by effective engagement with the public. Increasingly, improvement will be driven by the choices made by service users and healthy competition between different service providers. The NHS and adult social care services are no exception… The overall aim is to give people the best and safest care possible, with the best possible value for public money. We want to see effective management of the system backed by regulation that gives patients and service users confidence that whichever provider they choose, whether public, private or third sector, they can be assured of a safe and high quality service.’
The department’s proposal was that the new independent regulator would have a key role in ensuring providers would meet national standards and would provide an independent assessment of commissioners and NHS providers. The Audit Commission would continue to play a role in ensuring the proper use of public funds through primary care trusts (PCTs) and strategic health authorities (SHAs). Monitor would continue to be the independent regulator of foundation trusts.
The document explored the role of market and competition regulation and explained that new competition rules would be published in 2007 to clarify European legislation. It was envisioned that commissioners would have a role in ensuring a ‘fair playing field’ and in encouraging a diverse range of providers locally. Nationally, the regulatory framework and pricing policy would ensure a fair playing field between all types of provider. The department proposed to offer providers the right of appeal to a strategic health authority where there was a dispute between a commissioner and a provider. The department also suggested an independent appeals process to the new merged regulator due to economies of scale. However, it was noted that the Office of Fair Trading would have an interest in the rules governing competition.
The department emphasised the importance of the independent regulation and inspection in social care due to the absence of a regional intermediate tier such as the strategic health authorities in the NHS. Additionally, it was recognised that approximately one-third of social care users were self-funders. The new regulator would ensure that all care home and domiciliary care providers met national standards.