NHS regulatory turmoil distracts from the real business of care

In the last six days, HSJ has revealed both the resignation of Care Quality Commission chair Barbara Young and the failure of the Department of Health to find a chair for Monitor.

The refusal of politicians to be honest about the nature of risk propels them down the route of increasingly oppressive regulation

With the government, Monitor, CQC and the National Patient Safety Agency pointing in different directions on patient safety, it is little wonder ministers are struggling to both keep and appoint regulator chairs.

It is not just the public who are losing confidence in the system. Managers are bewildered. It is, as one put it, a mess.

The problem is exacerbated by the perpetuation of the myth that regulatory systems can remove error from public services. Remarks made by ministers when a scandal breaks too often encourage the public to think that if only the regulatory system was better then patients would never avoidably die.

The refusal of politicians to be honest about the nature of risk propels them down the route of increasingly oppressive regulation, which can never achieve its aim.

Anyone thinking of applying for either chair would do well to get some straight answers from the Department of Health about the boundaries of autonomy and power. The department’s fractious relationship with outgoing Monitor executive chair Bill Moyes is openly discussed, while the battle with the CQC over its role and sanctions are now all too apparent.

Repeated reforms of the regulatory system have failed to deliver a structure which is credible, effective and proportionate. More change seems unavoidable - and yet again it will distract from patient care.