The new Health and Social Care Bill could radically change the way healthcare is regulated. Susan Thompson explains

The Health and Social Care Bill progressing through Parliament has at its heart the aim of improving health and social care to protect the public.

It offers an integrated approach to regulating the health and social care sector and its workforce. It also puts forward plans for new measures in public protection, as well as initiatives ranging from health grants in pregnancy to extending direct payments in social care.

The new Care Quality Commission proposed in the bill is described by the government as a tough new regulator for health and adult social care focusing on safety and quality.

Under the proposals, the new commission will start operating in shadow form soon and become fully operational in April 2009. It will regulate standards across public and private sector providers and will have strong enforcement powers to ensure compliance. Spot fines are proposed, as well as powers to suspend or close services, wards or even hospitals where there is a serious risk to patient safety.

Reservations

However, the three current regulators, the Healthcare Commission, the Commission for Social Care Inspection and the Mental Health Act Commission, have expressed serious reservations about the planned merger.Concerns have been raised about maintaining the independence of the new regulator, and that social care and mental healthcare regulation could be marginalised by health under the new system.

Another concern is that there is no obvious consumer or patient involvement in the structure, in contrast to other regulators of consumer services, such as telecommunications regulator Oftel.Individual complaints will not be dealt with by the commission.Dissatisfied customers will have to go straight to the health service ombudsman. Some sceptics have argued that there is nothing to reassure the public that complaints will be dealt with effectively or independently.

The scope of regulation under the new body remains unclear and also what the requirements of registration will include.Self-regulation will become the norm, with the commission targeting areas which cause concern, rather than undertaking inspections routinely.

Road ahead

There is still much lobbying to be done on the framework bill and on any draft regulations and standards. Like most primary legislation, the devil will be in the detail. As Dame Denise Platt commented to the public bill committee: "It is a piece of framework legislation. There is a floor plan, but we do not know whether it is a bungalow or a skyscraper in Canary Wharf."