Responses to HC 1428, on the Annual accountability hearings with the Nursing and Midwifery Council (ISBN 9780215560933); 1429 on the Annual accountability hearings with the General Medical Council (ISBN 9780215560926) & 1430 on the Annual accountability hearings with the Care Quality Commission (ISBN 9780215561305)
In this first annual accountability hearing with Monitor, the Health Committee welcomes the strengthened role given to the hospital regulator in the approval and regulation of Foundation Trusts. The Committee strongly supports the view that the standards for authorizing Foundation Trusts must not fall as a result of the Government's desire to see all remaining NHS Trusts become Foundation Trusts. It welcomes the extension of Monitor's oversight powers for Foundation Trusts to 2016; that the powers will then be reviewed; and the fact that Monitor's new role, as set out in the Health and Social Care Bill, has been more clearly defined. The Committee believes Monitor has established a reputation as an effective regulator of Foundation Trusts and that it is important to safeguard that hard-won reputation. That means insisting on the maintenance of a rigorous approvals system. It also means maintaining an effective oversight regime in what are likely to be increasingly challenging times. Finally, following government amendments to the Health and Social Care Bill which were tabled at Commons Report Stage, it means the operation of an effective distress and failure regime for Foundation Trusts.
The Health Committee reports on the annual accountability hearings with the General Medical Council (GMC) (HC 1429) and Nursing and Midwifery Council (NMC) (HC 1428). The reports call for doctors and nurses to develop a wider responsibility for the overall quality of care delivered to patients and they have an obligation as professionals to report to their professional body any concerns they have about the quality of care being delivered by their colleagues. The GMC and the NMC must give a strong lead in this area and ensure that failure to act on this responsibility is regarded as a serious breach of professional obligation. The Committee stresses that both regulators need to have effective revalidation processes in place so that they can periodically check on how doctors and nurses are performing. The Committee recognises that the NMC is making steady progress towards being an effective regulator but cautions that there remains substantial ground to cover before it can be considered fully effective: work around pro-active regulation (risk-based visits) must be expanded; guidance about the care of older people must be reinforced by an action plan to deliver improved outcomes in this group. Government and both regulators must speed up efforts to resolve the serious problems posed by doctors and nurses who qualify elsewhere in Europe, and earn the right to work in the UK without having their language or medical skills tested. The UK and European law that underpins the workings of both regulators needs a complete overhaul.
Following its annual review of the work of the Care Quality Commission (CQC), the Health Committee reports that the bias of the work in the CQC away from its core function of inspection and towards the essentially administrative task of registration, represents a significant distortion of priorities. The Committee reports that: the CQC was established without sufficiently clear and realistic definition of its priorities and objectives; the timescales and resource implications of the functions of the CQC were not properly analysed; the registration process itself was not properly tested and proven before it was rolled out; the CQC failed to draw the implications of these failures adequately to the attention of ministers, Parliament and the public. Consequently, the Committee welcomes the government's decision to postpone registration of GP practices, and recommends that proper planning, including piloting of the model for registration, should be undertaken before the revised date of April 2013 is confirmed. The Committee also welcomes recent announcements that the CQC intends to undertake annual visits of all NHS and social care providers. It goes on to stress the importance of the role of inspectors in assessing the culture in care providers, especially concerning the obligation which rests on all healthcare professionals to raise concerns if they recognise, or ought to have recognised, evidence of failure of professional standards. Each provider organisation should recognise and respect this professional obligation and provide proper security to those professional staff who discharge it effectively.
The Health Committee reports on the annual accountability hearings with the General Medical Council (GMC) (HC 1429) and Nursing and Midwifery Council (NMC) (HC 1428). The reports call for doctors and nurses to develop a wider responsibility for the overall quality of care delivered to patients and they have an obligation as professionals to report to their professional body any concerns they have about the quality of care being delivered by their colleagues. The GMC and the NMC must give a strong lead in this area and ensure that failure to act on this responsibility is regarded as a serious breach of professional obligation. The Committee stresses that both regulators need to have effective revalidation processes in place so that they can periodically check on how doctors and nurses are performing. Whilst the GMC is recognised as a high performing medical regulator, the report calls for: greater transparency in the process for doctors seeking to remove themselves from the medical register; stronger performance management of 'fitness to practice panellists' involved in adjudication of complaints; a clear right of appeal for the GMC so that it can challenge adjudication panel decisions it feels are unduly lenient. Government and both regulators must speed up efforts to resolve the serious problems posed by doctors and nurses who qualify elsewhere in Europe, and earn the right to work in the UK without having their language or medical skills tested. The UK and European law that underpins the workings of both regulators needs a complete overhaul.
GMC's fitness to practise successfully produces outcomes that protect patients from sub-standard doctors but failures to communicate the reasons for decisions and poor investigative practices have undermined a small number on investigations. The GMC should review its fitness to practice procedures to prevent such mistake. The Committee also found that while it is still too early to judge whether revalidation has been effective there is a worrying approach to the oversight of revalidation. Each designated body has a responsible officer for revalidating their medical staff, but the degree to which the responsible officer will be held to account is unclear. It is imperative that the GMC clarifies the personal responsibility and accountability of responsible officers. There is also concern over the number of responsible officers available to oversee the revalidation of doctors working in primary care. GPs are revalidated not by their own employers but by one of the 27 NHS England local area teams that oversees Clinical Commissioning Groups in England. Just 27 responsible officers will be tasked with overseeing revalidation for approximately 45,0000 GPs in England. The Government's intention had been to give the GMC the power to allow it to appeal decisions made by the Medical Practitioners Tribunal Service (MPTS) in 2014 by using a mechanism in secondary legislation called a section 60 order. The Government now plans to introduce the reform in primary legislation as part of a proposed Law Commission Bill thus meeting with even further delay
This year's accountability hearings focused on three areas of particular interest: the arrangements for revalidation of doctors, which are to commence on 3 December 2012, and associated matters such as patient involvement and examination of the language competence of doctors; the professional leadership activity undertaken by the GMC in the last year; and the regulation activity undertaken by the GMC, including the establishment of the Medical Practitioner Tribunal Service. The Council is performing effectively in its two roles of defining and applying standards for the medical profession and providing a focus of professional leadership. The outcome of the Law Commission's consultation on professional regulation in the health and care sector, which proposed a formal role for the Health Committee in the accountability structures, is still awaited. Specific concerns included that whilst there has been some progress on the amendment of domestic legislation which restricts the language testing of doctors this is no substitute for the revision of the European legislation which presently prohibits language testing of doctors on a national basis. There have also been continued upward trends in complaints against doctors received by the GMC, and the Committee expects to examine in 2013 the outcomes of further research the GMC has commissioned into these trends. The Committee feels that the present 15-month target for the GMC to complete 90% of its fitness to practise cases should be lowered to 12 months. The Committee also welcomes proposed legislation to enable the GMC's investigatory arm to appeal against decisions made by the MPTS where the outcome of a hearing is disputed
A draft Law Commission Bill on the regulation of health and social care professions sets out the framework for a negative register, but it was not included in the Queens' Speech either as a draft or a substantive Bill. The Government needs to set out what changes to the powers of regulators it is planning to make through secondary legislation instead. Following up themes in the Francis report, regulators need to be visible and accessible to registrants, and also to patients and members of the public who wish to raise concerns about patient safety. Since 2003, the HCPC has recommended that statutory regulation be extended to a further eleven professions from the current sixteen. Of these, the only groups to receive statutory regulation to date are operating department practitioners and practitioner psychologists [the other groups are Clinical Perfusion Scientists, Clinical Physiologists, Dance Movement Therapists, Clinical Technologists, Medical Illustrators, Maxillofacial Prosthetists & Technologists, Sports Therapists, Sonographers and Genetic Counsellors]. The HCPC should list any professional groups for which they feel there is a compelling patient safety case for statutory regulation so that this can be pursued with the Department of Health as a matter of urgency. There is also concern at the length of time it can take for professional groups to gain statutory regulation. Given that new groups can be added to the HCPC's register by means of secondary legislation, there should be no undue delay in extending statutory regulation to professional groups where there is a compelling patient safety case for doing so
This year's inquiry into the work of Monitor concludes that the model of care provided by the health and care system is not changing quickly enough with the result that pressures continue to build, threatening the financial stability of individual providers, and therefore the quality of care provided The pressures are likely to be particularly marked in the acute sector as plans are prepared and implemented to achieve the resource transfer required by the introduction of the Better Care Fund from April 2015. Continuing this theme, the Committee argues that as the NHS financial situation tightens, the challenge for Monitor in supporting trusts in financial difficulty is likely to increase. The MPs emphasise the importance of addressing pressures within individual providers in the context of the local health economy. The requirement for major change in the care model can only be delivered if individual providers, and Monitor as their regulator, look beyond preserving existing structures and address the need to develop different structures to meet changing needs. The Committee also expresses concern that Monitor has not done enough to reform the system of tariff payments for providers, arguing that the current tariff arrangements often create perverse incentives for providers and inhibit necessary service change. It recommends that Monitor and NHS England should initiate a formal joint process for a prioritised review of the NHS tariff arrangements with the objective of identifying and eliminating perverse incentives and introducing new tariff structures which incentivise necessary service change
