The refusal to merge NHS provider regulation into a single organisation could leave the system open to mistakes, Robert Francis QC has told HSJ.

In his report of the Mid Staffordshire Foundation Trust public inquiry Mr Francis recommended the Care Quality Commission’s take on Monitor’s oversight of “corporate governance” and “financial competence”.

He made the comments to HSJ in his first in-depth interview, saying merging regulatory functions would prevent a repeat of the communication failure between the two regulators that saw Mid Staffordshire authorised as a foundation trust despite the CQC’s predecessor, the Healthcare Commission, having serious concerns about quality.

The government has rejected the idea of a merger, although it has introduced measures to make the regulators work more closely together.

Mr Francis told HSJ: “What is absolutely vital is there should be no chink at all between the way in which the two things are done. I would still remain concerned at the vulnerability such a system has in having two leaderships, however good they are, because the experience of Stafford shows the way in which two organisations work together does depend quite a lot on the personalities and relationships of the people who run them.

“I’m not sure that necessarily provides the best hope of making sure things are safe.”

Mr Francis praised the proposed changes to the CQC’s inspection regime, to include more health professionals. This was the “only form of regulatory oversight that had worked”, he said. He also welcomed the proposed appointment of a chief inspector of hospitals.

The proposed new inspection regime will compare services within hospitals as well as between sites.

Mr Francis also said he supported the move by NHS England medical director Sir Bruce Keogh in March, which saw Leeds General Infirmary suspend its children’s heart surgery services.

He said this was “precisely the approach I would advocate” and added: “There was information that could indicate a cause for concern, if that concern was true then patients were at risk. Therefore the safe thing to do was to call a halt, review the situation and then decide what to do.

“As an approach, stop, look, decide what to do; that seems a sea change from what has happened to date.”

Asked about the use of mortality rates, Mr Francis said: “To assert that no deaths were caused by poor care at Stafford is equally as unacceptable as saying 150 were caused by poor care. It is rather sad we can’t come to a conclusion one way or the other.

“The important thing is not to be diverted by an arid argument about overall mortality rates from the horror of the care being provided to a significant number of patients at Stafford.”