The Care Quality Commission should take on responsibility for “corporate governance” and “financial competence” alongside quality, Robert Francis QC has recommended.
The proposals for a single quality regulator, set out in the three-volume Report of the Mid Staffordshire Foundation Trust Public Inquiry, call for various functions of Monitor to be merged into the CQC.
Mr Francis warns ministers to “avoid the temptation” of abolishing both regulators and starting again.
He writes: “A merger of the system regulatory functions between Monitor and the CQC should be undertaken incrementally and after thorough planning. Such a move should not be used as a justification for reduction of resources… it would be vital to retain the corporate memory of both organisations.”
The recommendation follows evidence to the inquiry that the CQC’s predecessor the Healthcare Commission and Monitor had not worked well together. This led to the trust becoming authorised as a foundation trust despite the Healthcare Commission having serious concerns.
Mr Francis has also recommended the CQC be given more powers to bring criminal prosecutions. Concluding that the Health and Safety Executive is “clearly not the right organisation to be focusing on healthcare”, Mr Francis calls for the CQC to be given comparable legal powers to bring prosecutions.
He also recommends providers should be criminally liable for a “breach of fundamental standards”.
The prime minister responded to Mr Francis’ report this afternoon, with a detailed response published in coming months.
The inquiry report makes clear that, under Mr Francis’s proposals, responsibility for authorising foundation trusts would pass to the CQC.
It states that, in the case of Mid Staffordshire, an “erroneous FT authorisation” was made because important information about the trust did not pass between the two regulators.
“The assessment of risk to patients would be more effective if the direct monitoring of compliance with fundamental standards and the monitoring of the organisation’s ability to deliver compliance were the responsibility of one organisation,” it continues.
“The responsibility for the FT authorisation process should also be transferred. There is no logical case to have these issues dealt with by different bodies. The single regulator should deal with issues of patient safety, adherence to fundamental standards, corporate governance and financial competence and viability.”
“The Secretary of State should therefore consider transferring the functions of regulating governance of healthcare providers and fitness of persons to be directors, governors or equivalent persons (as dealt with elsewhere in the recommendations) from Monitor to the CQC.”