The must read stories and debate in health policy

Francis’ regulation revamp

The architect of the fit and proper person test for board directors in the NHS, Sir Robert Francis, has written for HSJ, casting doubt on the effectiveness of the legislation and suggesting senior NHS managers should be regulated as part of a reformed professional regulatory system.

Sir Robert’s concerns echo criticism of the Care Quality Commission, which has been accused of not effectively enforcing the powers which allow it to remove a director from a board if they are deemed unfit.

The CQC is now reviewing the fit and proper person test with a report due out next year.

Sir Robert first called for regulation of senior NHS managers to ensure public trust and confidence in boards in his first independent investigation into poor care at Mid Staffs. In his latest article, he says the current system of professional regulation needs to change to be more focused on system issues and learning rather than blaming an individual clinician.

The new Healthcare Safety Investigation Branch has a key role to help the NHS learn and investigate mistakes, and a crucial ingredient is a legal safe space for NHS staff to be honest about why errors might have happened.

This was a very specific recommendation of expert advisers who helped design HSIB in the wake of the Morecambe Bay care scandal.

But the government is considering a plan to go much further, extending the safe space to all NHS trusts and organisations investigating incidents on their behalf.

In response to the consultation plans, members of the original expert group warned the plans were “dangerous” and would fail.

There are fears local trusts will abuse the legal protection and taint the work of HSIB before it gets properly under way.

Giving evidence to MPs this week, HSIB chief investigator Keith Conradi said he believed the safe space powers should be limited to the branch alone.

PCS problems

One of the most lively conversations on hsj.co.uk this week has been around Capita’s controversial primary care support services contract.

The company has been widely criticised since it took over PCS last September, with widespread reports of services deteriorating after it began centralising services and closing local offices.

In a debate on the contract on Tuesday evening, health minister Nicola Blackwood said that bids for the PCS contract were assessed for quality and cost, and had been scrutinised by the Department of Health and the Treasury – but it is now “evident that Capita were inadequately prepared for delivering this complex transition”.

NHS England has also admitted Capita’s poor performance has had an “unacceptable impact on patients”, and that the firm has failed to maintain the previous quality of services.

A Capita spokesman said: “We have taken on this challenging initiative and we have openly apologised for the varied level of service experienced by some service users as these services were transitioned and are being transformed. We have mobilised extra people and management to ensure that we can deliver an improved service.”

The rating game

There were two significant stories about CQC ratings changes on Wednesday.

First, Sherwood Forest Hospitals Foundation Trust has demonstrated enough improvement in safety in its most recent inspection in July to be removed from special measures. The trust has moved from inadequate to requires improvement.

Sherwood Forest was one of the first batch of NHS trusts put in special measures in 2013. Two of the initial 11 hospital trusts placed in special measures after the Keogh review remain in the regime.

Second, the CQC has upgraded nine of its service ratings for The Royal Wolverhampton Trust following an appeal from the provider – the most changes the regulator has ever made after an ratings review.

The trust lodged an appeal against 14 of its 118 service ratings from its July 2015 inspection. A CQC spokeswoman said seven ratings were changed after challenge by the trust, and two more were a result of the review team’s assessment.

The trust remains rated requires improvement overall.