Monitor and the Care Quality Commission are developing a “single failure and distress regime” which aims to increase the consequences of quality failures for trusts.

In an exclusive interview with HSJ CQC chief executive David Behan told HSJ the CQC was also planning to review its core standards.

The plans are in response to last month’s Francis report into the failure of regulators and others to spot and act on care failings at Mid Staffordshire Foundation Trust.

In his report Robert Francis QC recommended the CQC take on Monitor’s powers over financial and corporate governance of foundation trusts. HSJ understands this is unlikely to be enacted but the government wants to increase the consequences of care failures.

CQC chief executive David Behan told HSJ the CQC and Monitor were working together to develop the system.

Mr Behan said there would be a “greater emphasis on judgements [the CQC makes] about quality” in the “single failure and distress regime” than under the current compliance system.  

He said: “That assessment will be undertaken by the CQC staff and the enforcement left to Monitor. That’s the way it’s being considered at the moment, using the powers that exist. There is a lot of detail that needs to be worked through in relation to that.”

It suggests the prospect of Monitor losing a significant part of its role to the CQC − raised by Francis − is unlikely to take place.

In relation to other Francis recommendations, Mr Behan revealed the regulator planned a major review of the 16 core standards which it judges trusts against during 2013-14, although he said it would not make “change for change’s sake”.

Mr Francis proposed the CQC should focus on ensuring compliance with a set of fundamental standards while developmental and aspirational standards should be a matter for commissioners.

Mr Behan told HSJ: “What Francis means by fundamental is things like people left lying in their own excrement.

“As a regulator that’s responsible for ensuring that services are safe and are of good standard we also know just how important the leadership and culture of an organisation is.”

The standards review will involve consultation with the public and clinicians, in line with another of Mr Francis’ recommendations.

Ahead of the review the CQC has identified four “domains” which it will focus on in 2013-14. Three of these relate to the components of former health minister Lord Darzi’s definition of quality – safety, effectiveness and patient experience. Mr Behan’s forth domain is leadership and culture.

Mr Behan said the CQC would look at how organisations dealt with concerns from staff and patients as an indicator of an organisation’s culture as well as staff survey results, and particularly whether staff would recommend their organisation to friends or family.

Monitor told HSJ it was “still working through what the ‘single failure regime’ means in the future and how it would work” in discussions with the CQC and Department of Health.