Healthcare Commission longed for government's embrace

Sir Ian's article, published in an internal newsletter, is a candid reflection on the commission's achievements and failures as it prepares to make way for the Care Quality Commission next April.

It also provides an insight into the regulator's relationship with the government.

Sir Ian said: "Given the highly politicised nature of any discussion of the NHS, government both saw the need for the regulator and at the same time felt uncomfortable about it, particularly when it brought bad news.

"Regulation was sometimes seen as part of the problem rather than part of the solution."

Legislation limiting the commission to assessing the performance of organisations, rather than care pathways or GP practices, tied the commission's hands and was a "handicap", he said.

He "would have liked the annual health check and the broader role of the regulator to have been embraced more warmly by government".

Sir Ian said it was a "great regret" that the annual health check had not examined pathways.

He also wished the commission had been able to publish performance ratings in the same year as inspections, and had used patient experiences to inform assessments.

The recognition of the need to keep a better check on the financial services industry was an opportunity for the CQC to "cement the role of regulation" in the NHS, he said.

Sir Ian has clashed with ministers in the past, behind closed doors. In a letter leaked toHSJ , he rejected criticism from health secretary Alan Johnson that the commission had been slow to act over the infection outbreak at Maidstone and Tunbridge Wells trust.

In the letter, Sir Ian said an effective strategic relationship between the commission and Department of Health had been historically "difficult to achieve" and there had been little access to top decision makers.

Read Sir Ian's full article on his reflections about the annual health check