UK - The Health Foundation: new research assesses impact of healthcare regulation

Citation

(2007), "UK - The Health Foundation: new research assesses impact of healthcare regulation", International Journal of Health Care Quality Assurance, Vol. 20 No. 4. https://doi.org/10.1108/ijhcqa.2007.06220dab.005

UK - The Health Foundation: new research assesses impact of healthcare regulation

Keywords: Health services, Standards, Governance, United Kingdom

Inspections, targets, standards, and mandatory reporting can make a difference to the quality of healthcare, according to latest research published by The Health Foundation. What Impact Does Regulation Have on the Quality of Healthcare?. Looks at the extent to which regulatory mechanisms impact on the quality of care provided. The most up-to-date information available suggests that further attention should be given to the way the professions are regulated and how patient outcomes data are collected and reported. Findings from the USA also suggest that market forces can have negative consequences for some patients.

Commenting on the research, Vin McLoughlin, Director of Programmes and Policy at The Health Foundation, said: “Regulation is expensive. We all need to know whether the radical proposals that are already on the table, such the merger of the Healthcare Commission with the Commission for Social Care Inspection and the Chief Medical Officer’s report on the regulation of doctors, will lead to better patient care. This research provides the best available evidence to guide the future direction of regulation.”

The main findings of the research are:

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  Targets – Despite some public criticism, when targets are focused on specific objectives, are limited in number, and are combined with other performance management interventions, they are proven to be effective. Used in an appropriate way, targets will help bring about improvements in quality. The setting and monitoring of challenging targets should not be abandoned.

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  Inspection – The prospect of inspection alone can encourage organizations to focus on measuring and improving their performance. It can help to ensure accountability. Patients can also use the results to make informed decisions about their care. However, the impact of inspection depends on the methodology used and the quality of the recommendations. Staff need support to both act on the findings and implement the recommendations.

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  Standards – National Service Frameworks (NSFs), particularly the coronary heart disease NSF, have been instrumental in driving up the quality of care. Guidance from the National Institute for Health and Clinical Excellence has also played an integral role. Clinical outcomes need to be measured and reported across a wide range of conditions to assess whether standards have had the desired effect.

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  Mandatory reporting – Evidence from the USA shows that publicly reporting performance can have a positive effect on care, especially when it’s mandatory. Public reporting of clinical performance is at an early stage in the UK and existing efforts to record heart surgery survival rates should be replicated in other specialties.

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  Professional regulation – The evidence supports the proposals accepted by the government in the CMO’s report, Good Doctors, Safer Patients and suggests that professional-led, publicly reported regulation of doctors is more effective than employer-led regulation. The existing UK regulation of medical professionals needs to change in line with the CMO’s proposals for local regulation, revalidation and the use of clinical audit data for specialist recertification.

Although Foundation Trusts cannot be directly compared to US, for-profit providers, the research points out lessons that could be learned from the US system. Converting hospitals from non-profit to for-profit status in the US has had some detrimental effects on healthcare quality such as increased mortality rates. In some instances, healthcare inequality has widened. The research suggests that vigilance is needed when overseeing Foundation Trusts to make sure similar effects are not seen in England and Wales. Furthermore, the US experience of rate-setting supports the revised framework for Payment by Results which allows more sophisticated payments and aims to avoid “gaming” of the system.

For further information: www.health.org.uk/aboutus/publications/