Regulators are in a strange place right now. With all parties engaged in a Dutch auction over the future size of the public sector, quangos are easy targets for spending cuts.
Inspection and regulation watchdogs have already been downsized, merged and abolished with alarming speed.
The new Care Quality Commission is as much a product of efficiency savings as of rational argument about joined-up inspection. The King’s Fund has raised concerns that in taking over so many different aspects of care regulation the CQC might have bitten off too much.
Ironically, the same financial pressures that have produced a cull of the quangos are also increasing the regulatory workload, as care standards risk being compromised.
NHS trusts will need to make deep savings post-2011, while care homes are having to cope with diminished fees. Mental health services are stretched to the limit too. Suddenly, light-touch, slimmed-down regulation doesn’t look such a clever idea.
An early warning of the risks from under-regulated services came this week, with news that a lethal dose of painkiller was given by a German locum, while working for an out-of-hours firm contracted to a Cambridgeshire health trust.
The CQC is investigating this specific case, but its inquiries need to range far wider. Astonishingly, most primary care — which accounts for 90% of NHS treatment — falls outside the orbit of government regulators.
This is about to change, as GPs will have to register with the CQC from 2011 and face an ‘MOT’ every five years.
But out-of-hours care, on which many vulnerable patients heavily rely, remains a grey area. Under their generous 2004 contracts, the vast majority of GPs opted out of running this service, which is largely contracted to a range of providers by PCTs.
Critics say the system is confusing, costly and adds to pressures on A&E departments. Defenders point to the deficiencies of the old GP-run out-of-hours cover, which was patchy at best.
Either way, it is an area ripe for investigation – and better regulation. Just one more thing for the new commission to add to its in-tray.
