Ofcare: 'Ambitions and metrics' mark launch of a new regulatory era

A document leaked to HSJ this week lays out the new regulatory landscape for the health service.

From 2009 Ofcare - the Office of Health and Adult Social Care - will take its place alongside Ofsted, Ofwat and Ofcom (Click here for the full story).

Acute, community and mental health services, alongside care homes, will make up the bulk of its work.

Unlike its new regulatory siblings, Ofcare will be able to charge institutions that need to register to provide services. The civil service syntax describes this as ensuring a level playing field - the Healthcare Commission already.charges independent providers to register, for example, and the Commission for Social Care Inspection charges councils.

Ofcare responsibilities will include safety and quality assurance and taking action over serious failures.

Tough penalties

Its sanctions regime will include statutory warning notices demanding improvements, formal cautions, temporary suspension of registration, restrictions on what can be provided, or triggering criminal prosecution. Failing trusts and services could be closed by losing their registration.

It will also be empowered to impose fines. The precise rules governing. such an imposition are unclear, but.one specific proposal is for an 'administrative fine' for failures over safety and quality.

The boundaries of Ofcare's powers of intervention are double-edged. On one hand it has 'broad powers÷ coupled with discretion about how and when to use them', but it will not be able to impose remedies, only offer suggestions to struggling services.

Ministers are trying to sell the.message that the current wave of regulatory reforms across the public sector is taking a more intelligent approach to balancing inspection. with risk.

To this end Ofcare will turn an intense spotlight on new providers, while established success stories could be left untroubled for several years.

The performance framework itself commences with mea culpa, admitting what healthcare professionals have been telling the Department of Health for years - top-down targets undermine innovation, motivation and accountability to communities.

Ambitions and metrics

These targets will be replaced by no more than 40 'ambitions and metrics', although an appended note on behalf of health minister Lord Hunt pleads for more intelligible language to be used in the final document. The 40 measures.are intended to encompass the whole range of outcomes for health and.social care, and will be the focus of a substantial public consultation exercise. These will drive locally determined service improvements, with a heavy emphasis on integration of health and social care.

There are some telling comments on the draft from Lord Hunt's office. Years of experience at the senior levels of government come to bear when he questions the assertion that transferring existing NHS providers to the new body 'will be immediate and involve minimal bureaucracy' - 'can you assure me of this?' he asks.

More substantively, several of the comments highlight the DoH's uncertain approach to local government. A note on behalf of the minister says he wants to know 'if colleagues in social care seen [sic] the document? There is not much on local authorities and social care - will they expect more?'

A later reference to the fact that local government's 'authority comes from democratic accountability' is simply deleted.

Overall, the draft plan for Ofcare certainly provides a regulatory framework which service users will find more transparent and intelligible. But determining the 40 health promises underpinning the new regime will be tough.

They must deliver a framework which is neither so bland that it is devoid of meaning or challenge, nor too specific to encourage local initiative.