The Evolution of External Healthcare Regulation in England; From Performance Oversight to Supporting Improvement; Comment on “The Special Measures for Quality and Challenged Provider Regimes in the English NHS: A Rapid Evaluation of a National Improvement Initiative for Failing Healthcare Organisations”

Document Type : Commentary

Authors

Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK

Abstract

The Special Measures and Challenged Provider (SMCP) Regime introduced for struggling healthcare organisations in England represents a subtle shift to the scope of external regulation from performance oversight to include supporting internal service improvement. External regulation alone has a had a mixed impact on the quality of care and Vindrola-Padros and colleagues’ study highlights that externally driven improvement initiatives may also struggle to succeed in turning around performance. Principally, this is due to a failure in acknowledgment that poor performance results from a myriad of external and internal factors which coalesce to impede organisational performance. A struggling organisation may be indicative of wider issues in the local health and care system. Whole systems approaches to improvement with collaboration across providers and the effective use of data may support struggling organisations but their role maybe tempered with the increased centralisation of the delivery of improvement regimes such as SMCP.

Keywords


  1. Vindrola-Padros C, Ledger J, Hill M, Tomini S, Spencer J, Fulop NJ. The special measures for quality and challenged provider regimes in the English NHS: a rapid evaluation of a national improvement initiative for failing healthcare organisations. Int J Health Policy Manag. 2022. doi:34172/ijhpm.2022.661
  2. Bevan G. Changing paradigms of governance and regulation of quality of healthcare in England. Health Risk Soc. 2008;10(1):85-101. doi:1080/13698570701782494
  3. Haslam D. What is the Healthcare Commission trying to achieve? J R Soc Med. 2007;100(1):15-18. doi:1177/014107680710000109
  4. Walshe K, Boyd A, Bryce M, et al. Implementing medical revalidation in the United Kingdom: findings about organisational changes and impacts from a survey of Responsible Officers. J R Soc Med. 2017;110(1):23-30. doi:1177/0141076816683556
  5. Bevan G. Regulation and system management. In: Understanding New Labour’s Market Reforms of the English NHS. London: The King’s Fund; 2011.
  6. Smithson R, Richardson E, Roberts J, et al. Impact of the Care Quality Commission on Provider Performance: Room for Improvement? The King’s Fund; 2018.
  7. NHS Providers. Special Measures: Five Years On. https://nhsproviders.org/special-measures-five-years-on. Published 2018.
  8. Purohit K. The National Health Service's 'special measures': Cambridge - a case study. Health Serv Manage Res. 2021;34(3):193-197. doi:1177/0951484820931061
  9. Lawton R, Thomas EJ. Overcoming the 'self-limiting' nature of QI: can we improve the quality of patient care while caring for staff? BMJ Qual Saf. 2022;31(12):857-859. doi:1136/bmjqs-2022-015272
  10. Mandel KE, Cady SH. Quality improvement as a primary approach to change in healthcare: a precarious, self-limiting choice? BMJ Qual Saf. 2022;31(12):860-866. doi:1136/bmjqs-2021-014447
  11. Vaughn VM, Saint S, Krein SL, et al. Characteristics of healthcare organisations struggling to improve quality: results from a systematic review of qualitative studies. BMJ Qual Saf. 2019;28(1):74-84. doi:1136/bmjqs-2017-007573
  12. Dixon-Woods M, McNicol S, Martin G. Ten challenges in improving quality in healthcare: lessons from the Health Foundation's programme evaluations and relevant literature. BMJ Qual Saf. 2012;21(10):876-884. doi:1136/bmjqs-2011-000760
  13. Single Assessment Framework. Care Quality Commission. https://www.cqc.org.uk/about-us/how-we-will-regulate/single-assessment-framework. Published 2022.
  14. NHS System Oversight Framework 2021/22. NHS England; 2021.
  15. West D. Majority of Providers in Some ICSs to be Performance Managed by NHSE. Health Service Journal (HSJ); 2022.
  16. Uggerby C, Kristensen S, Mackenhauer J, et al. From accreditation to quality improvement-The Danish National Quality Programme. Int J Qual Health Care. 2021;33(2):mzab071. doi:1093/intqhc/mzab071
  • Receive Date: 09 November 2022
  • Revise Date: 23 January 2023
  • Accept Date: 25 January 2023
  • First Publish Date: 28 January 2023