Just one breach of new fundamental standards to be developed by the Care Quality Commission would see a provider tipped into a new “single failure regime” – but all enforcement action will be left to other regulators, HSJ has been told.

In his Report of the Mid Staffordshire Foundation Trust Public Inquiry, Robert Francis QC called for the creation of a set of fundamental standards. Breaches of these standards, which Mr Francis suggested could include factors like ensuring patients had been fed and cleaned, should not be tolerated, and lead to service closure, he said.

As reported by HSJ earlier this month, the CQC is to review its 16 core standards and will seek views on new measures organised around the four domains of safety, effectiveness, experience and leadership and governance.

CQC chair David Prior told HSJ these domains would include fundamental standards, as envisaged by Mr Francis.

He said: “If we find hospitals are breaking a fundamental standard we would tip them into the failure regime. It’s one strike and you’re out because at that level of rock bottom floor level, that is long term neglect. That is what he [Mr Francis] is saying.”

In cases where organisations have breached other standards, they will typically be given between three and six months to make improvements before being put into the failure regime.

The idea of a “single failure regime” for providers, which gives at least equal weight to quality issues as to finance, was first mooted by prime minster David Cameron in his response to the Francis report.

Once an organisation is put in the regime by the CQC, it will be for Monitor or the NHS Trust Development Authority to decide what action should be taken. This could include removing board members or closing services.

Mr Prior said: “We will be in a position to make a judgement, without having to pick up the consequences of that judgement so we will be much freer… At the moment we back off from making a judgement like that because we’re thinking how do we [provide the service elsewhere], what do we do when the A&E closes or maternity closes?”

The final decision on whether a hospital should be placed into the regime would be for the chief inspector of hospitals, a new senior post to be appointed by the CQC. Mr Prior insisted the CQC would never bow to pressure from politicians or other parts of the system to hold off putting organisations into the failure regime because of difficulties in dealing with their problems.

Mr Prior said the ideal candidate for the chief inspector of hospitals would be a “highly respected clinician who has also been a chief executive of a hospital” although neither clinical nor management experience would be essential as long as the candidate could command respect across both worlds.

“When he or she makes a judgement about a hospital people [need to] think, that’s probably right. This is going to be a very high profile job within the British healthcare system, probably the highest profile job.”

It is hoped the new chief inspector will be in post by October.

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