Annual accountability hearings: responses and further issues - Health Committee Contents

1 Report

1.  We are publishing with this report the responses of the Government and the four regulatory bodies themselves to the accountability reports that the Committee produced last year.[2] The Committee believes that it proved to be a very useful and illuminating exercise and we shall be undertaking similar hearings this year once the organisations have published their annual reports.

2.  We have decided to take this opportunity to flag up what we see as some of the significant issues that we will want to discuss further this year, in the light of comments in these responses and of other relevant events.

Regulation of healthcare professionals

3.  The idea for instituting these annual accountability sessions came from our inquiry into the revalidation of doctors, the report of which was published in February last year. As current legislation makes the GMC accountable to the Privy Council, and given that there is no mechanism to make that accountability effective, the Committee proposed to exercise that function itself, on behalf of Parliament.[3]

4.   In its report on the GMC published in July 2011 the Committee argued that the Council still had a considerable amount of work to do before the implementation of revalidation as proposed in late 2012.[4] In its response, the GMC says that revalidation "remains [its] number one priority. We are determined and on track to introduce a system by late 2012 (subject to the Secretary of State's approval)."[5] The Committee welcomes this statement. In the light of the importance of this process to the quality of services delivered to patients, and of the status of the GMC as an independent regulator, the Committee looks to the GMC to give early and public notice if it concludes that delivery of this timetable is at risk.

5.  In its report on the Nursing and Midwifery Council, the Committee also raised concerns in respect of the revalidation process for nurses and midwives. It drew attention to the fact that, although minimum standards are set for hours of practice and professional development for nurses and midwives, the Council provides no mechanism either to establish whether even those minimum levels have been reached or to assess the quality of an individual's practice.[6]

6.  The Committee noted separately the complete lack of regulation for healthcare assistants, and argued that mandatory statutory regulation will be needed to maximise public protection. It also concluded, however, that the first priority of the NMC needs to be to improve its work on its current core functions before asking it to address additional responsibilities.[7]

7.  In its response to that recommendation, the NMC said that it welcomed the Committee's support "for a mandatory statutory regulatory model for healthcare support workers working under the direct supervision of nurses and midwives." It added that "We have begun a project to fully scope the cost, standards and training requirements needed for us to establish such a mandatory model".[8]

8.  The Committee received that initial response in October last year. Since then, there have been a number of developments at the NMC. The Chief Executive and Registrar has left for personal reasons, and the Department of Health has announced that the Commission for Healthcare Regulatory Excellence is to undertake a strategic review of the organisation.[9] We have now received an addendum to its response from the NMC.[10] In this it says:

We therefore support the government's announcement that Skills for Health and Skills for Care have been commissioned to develop common training standards and a code of conduct for healthcare support workers. We believe that together with the proposals for assured voluntary registration to be administered by the Council for Healthcare Regulatory Excellence (CHRE) and our own development of a delegation standard for nurses and midwives, this provides an effective framework for public protection.

The NMC has a challenging programme of work that we are committed to delivering particularly in making operational improvements to our fitness to practise service and developing a system of revalidation for nurses and midwives - two key recommendations of the Committee. The focus of our work and resources has to be on these priorities and therefore it is neither appropriate nor feasible for us to develop a mandatory model of regulation of healthcare support workers.[11]

9.  The Committee supports the NMC's intention to focus, as its first priority, on the revalidation and fitness to practise procedures for nurses and midwives. We also support additional focus on training for healthcare support workers, and believe the NMC should keep the regulatory structure for this element of the caring workforce under regular review.

10.  In its next meeting with the NMC, the Committee will wish to review the progress it has made towards strengthening its revalidation and fitness to practise procedures. The Committee will also wish to discuss with the NMC the outcome of the CHRE's review, and review those recommendations which may help the Council better to perform its core functions.

Professional responsibility

11.  In each of its reports on the GMC,[12] NMC[13] and the Care Quality Commission,[14] the Committee raised the issue of the professional responsibility of healthcare professionals. In particular healthcare professionals, as well as being required to meet all appropriate standards themselves, have a responsibility to report concerns about the work of those around them if they feel it fails to meet those standards.

12.  The Committee also acknowledged, however, that "doctors and other practitioners who have raised concerns about other staff have sometimes been subject to suspension, dismissal or other sanctions".[15] It held an evidence session on that issue in December, following press reports that doctors (and presumably other professional staff) were being asked, as part of the termination of employment process, to sign clauses in compromise agreements that were alleged to be quite clearly inconsistent with the obligations of those same doctors to raise concerns about the quality of practice within the employing organisation with the General Medical Council, their professional regulator. That session was useful, not least because the three NHS organisations which had been identified as entering into such agreements all said to the Committee that they had reviewed the situation and would no longer use such provisions.

13.  Gavin Larner, Director of Professional Standards at the Department of Health, told the Committee:

Most of us absolutely agree that such clauses are inconsistent with the [Public Interest Disclosure]Act and are not acceptable. As a result of The Times article, I wrote, on 28 November, to the two trusts concerned to draw this to their attention and to ask them to review their policies. Ministers have also agreed that, following this evidence session, we will write to all NHS organisations to remind them of their responsibilities. Monitor will be writing to foundation trusts on this matter as well. There is a consensus here that we need to encourage people to speak out. With anything that hits against that, and in particular that crosses the Act, we need to make sure the Service understands its responsibilities.[16]

14.  The Committee was pleased to have such a clear statement from the Department on the position, and this particular issue at least should now have been effectively dealt with. The Committee continues to believe that the effective exercise of professional responsibility is the bedrock on which high standards of patient care are built. It also continues to believe that there is an essential public interest in ensuring that professionals are protected against punitive action when they raise concerns about professional standards at their place of work. In view of the importance of these issues we intend to continue to pursue them in our sessions with the professional regulators later in the year.

15.  The Committee also looks forward to the findings of the Francis Committee of Inquiry into Mid Staffordshire NHS Foundation Trust and what it may have to say about the conduct of professionals there.

Care Quality Commission

16.  The Committee raised some serious concerns about the work of the Care Quality Commission in its report on that body. The main recommendations bear repeating:

"6.The Committee concluded that the bias in the work of the CQC away from its core function of inspection and towards the essentially administrative task of registration represented a significant distortion of priorities. Although the evidence presented by the CQC acknowledged this distortion of priorities and argues that corrective action has now been taken, the Committee believes it is important to understand how this misallocation of resources arose, not least in order to reduce the risk of the same thing happening again.

7. The Committee has identified the following factors which contributed to this distortion of priorities:

  • The CQC was originally established without a sufficiently clear and realistic definition of its priorities and objectives;
  • The timescale and resource implications of the functions of the CQC, in particular the legal requirement to introduce universal registration of primary and social care providers, were not properly analysed;
  • The registration process itself was not properly tested and proven before it was rolled out; and
  • The CQC failed to draw the implications of these failures adequately to the attention of ministers, Parliament and the public."[17]

17.  In its response, the Department of Health says that it

accepts the comments of the Committee and is aware of the challenges that CQC has faced in registering providers under the new registration framework to a challenging timetable. The Government looks to CQC as the independent regulator to undertake its regulatory functions efficiently and effectively, learning lessons from its experiences.[18]

18.  In fact the Department has done more than "look to" CQC, and undertook a performance and capability review of the organisation between October 2011 and February this year, conducted by a panel of senior officials and external reviewers, led by the Permanent Secretary.[19] This review has made twenty three recommendations under six headings.[20] It notes achievements by the CQC, acknowledges the problems, argues that the organisation is showing a greater focus on its core purpose and sets out issues to be addressed for the future. It is also critical of the Department's role as well as of CQC's performance.

19.  The performance and capability review is a substantial document which sets out some real challenges for the CQC. In our next session with CQC the Committee will wish to review the progress it has made against the twenty three recommendations of the review.

20.  It will also wish to review the progress of the CQC in responding to the recommendations of the Francis inquiry and the extent to which there are issues for the organisation beyond those identified in the performance and capability review.


21.  Of all the regulatory organisations that we met last year, the position of Monitor was the least certain. This was not due to any particular failings on the part of the organisation, but because its role is proposed to be changed under the provisions of the Health and Social Care Bill, and the precise nature of its new role was still a matter of debate. Several months later, the position remains unchanged. By the time we meet Monitor again later in the year, there should be greater clarity whatever happens to the Health and Social Care Bill. We look forward to discussing its future role in that context.

2   Health Committee: Seventh Report of Session 2010-12, Annual accountability hearing with the Nursing and Midwifery Council, HC 1428; Eighth Report of Session 2010-12, Annual accountability hearing with the General Medical Council, HC 1429; Ninth Report of Session 2010-12, Annual accountability hearing with the Care Quality Commission, HC 1430; Tenth Report of Session 2010-12, Annual accountability hearing with Monitor, HC 1431. Back

3   Health Committee, Fourth Report of Session 2010-12, Revalidation of Doctors, HC 557, para 7. Back

4   Health Committee, Eighth Report of Session 2010-12, Annual accountability hearing with the General Medical Council, HC 1429, para 12. Back

5   Ev 37 Back

6   Health Committee, Seventh Report of Session 2010-12, Annual accountability hearing with the Nursing and Midwifery Council, HC 1428, para 31 Back

7   Health Committee, Seventh Report of Session 2010-12, Annual accountability hearing with the Nursing and Midwifery Council, HC 1428, para 64 Back

8   Ev 23 Back

9   Written Ministerial statement, Nursing and Midwifery Council, Official Report, 26 January 2012, Col 25WS. Back

10   Ev 24 Back

11   ibid Back

12   Health Committee, Eighth Report, paras 43 and 44 Back

13   Health Committee, Seventh Report, para 19 Back

14   Health Committee, Ninth Report, para 53 Back

15   Health Committee, Eighth Report of Session 2010-12, Annual accountability hearing with the General Medical Council, HC 1429, para 44. Back

16   Professional responsibility of healthcare practitioners, 7 December 2011, HC 1699-i, Q83 Back

17   Health Committee, Ninth Report of Session 2010-12, Annual accountability hearing with the Care Quality Commission, HC 1430 , paras 6 and 7 Back

18   Ev 49 Back

19   Performance and Capability Review, Care Quality Commission, Department of Health, 23 February 2012. Back

20   The headings are; strategy, resources and prioritisation, accountability, engagement and communications, development of the regulatory model and delivery of the regulatory model. Back

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© Parliamentary copyright 2012
Prepared 7 March 2012