The Healthcare Commission 2004–2009. Regulating healthcare experience and lessons. (2009)

The Healthcare Commission published a ‘lessons learnt’ document in the month leading to its abolition. Its legacy report suggested that the government’s decision to establish an independent regulator was an important and in some respects brave step. As the system became more devolved, there was a case for effective regulation to provide strong guidance to people using services.

The report noted that the history of organisational regulation had been brief and that the word ‘regulation’ had not been commonly used in health and social care at an organisational level until the establishment of the Healthcare Commission and the National Care Standards Commission. The report noted that:

'Born perhaps from experience of the regulation of professionals, regulation was thought of in terms of policing – top-down, potentially oppressive, a stick without any carrot, and burdensome. This was not the commission’s view. Instead, the aim was to work with the grain of good practice and to recruit patients and professionals in identifying what was good, rooting out what was poor, and seeking to bring about the changes which would mean that the good would be the norm. To adopt this role of encouraging improvement creates tension, however, not least with those whose job it is to manage the system. Of course, healthy tension is a necessary feature of independent regulation.'

The report highlighted a range of common themes across the trusts that had been investigated: 

  • while patient satisfaction levels were high, further progress was needed to ensure person-centred care
  • many of the concerns about poor performance and investigations into service failures had highlighted poor leadership and governance, particularly in relation to the safety of care
  • information on outcomes of care had not been routinely reported, analysed or actioned at board level
  • more attention needed to be given to patient safety including the development of surveillance mechanisms, reporting and better comparative information
  • more attention needed to be given to the continued professional development and training of staff
  • in all of the commission’s major investigations, the boards of the organisations were not receiving adequate information about the quality of care that their organisations were providing
  • there had been a lack of clarity on what ‘good services’ meant: the commission felt that the government had been too focused on processes rather than outcomes
  • there had been a lack of attention to areas such as mental health, learning disabilities, equalities and the integration of health and social care in the national priorities set by the government.