02. Healthcare Regulation and how it all began…

These days, healthcare regulation appears to be all encompassing, touching all aspects of our working lives and the lives and well-being of our patients.  However it wasn’t always like this and many may be surprised to learn that that a national policy on the quality assurance of healthcare provision is less than twenty years old.

The White Paper, “The New NHS, modern, dependable” (I have linked the PDF below for all you regulatory geeks) was produced in 1997 in response, in part, to failings in care by the NHS which, sadly, still seem familiar today.  The paper identified lapses in quality and instances of variable care, and undertook to devise a new national performance framework to ensure high performance and quality.  The result was both the National Institute for Clinical Excellence to provide national guidance in clinical effectiveness and the Commission for Healthcare Improvement (CHI) to support and oversee quality of care at a local level.  CHI was established by the Health Act 1999, and in 2003 was subsumed by the Healthcare Commission (HC) as the HC brought under one umbrella CHI, the National Standards Commission (for domiciliary/residential care) and some of the functions of the Audit Commission.

A further reconfiguration of quangos was undertaken in 2004 joined the Mental Health Act Commission (hence the current emphasis on capacity), the Commission for Social Care Inspection and the Healthcare Commission to form the Care Quality Commission (CQC). The Commission was established by the Health and Social Care Act 2008, was created as a shadow organisation on 1st October 2008, and began formal operations on 1st April 2009.

The basis of the CQC’s authority came from the Health and Social Care Act regulations, which were were used to generate the Essential Standards, the method by which the CQC inspected healthcare providers.

Next time, I’ll be discussing some of the challenges faced by the CQC

Take care til then,

Chris

1. The New NHS, modern, dependable – 1997

01. Hello World and welcome to my brand new blog…

My name is Christine Sawyer and my company aims to help take the fear out of healthcare regulation.  I have never written about me before, I thought that I would begin with a short history of myself!!

CKS Compliance Consultancy Ltd isn’t really all about following the letter of the law and the regulations – although you’ll find with my system that you have all of this covered, it is about taking the standards that are set as best practice, and creating a culture where patient safety and good experience is assured.  Once the reasons for the rules are understood, following the regulations becomes simple.

I understand that this sounds a little pedestrian and even boring, but this is way preferable to opening the email from the CQC with your 20 weeks warning notice, and realising that you have no idea what they even want!

Firstly, a little about myself.  My real working life began in the 90’s as a qualified bank nurse in Middlesbrough.  It wasn’t long before the bank rotated me onto the cardiothoracic surgical ward, where the combination of adrenaline, testosterone and power tools had me hooked from the very first day.  I learned here what a transformative experience cardiac surgery can be.

I then spent two years in Saudi Arabia, learning how to be a senior nurse in a strange land.  As part of the process of coming to grips with an alien culture (to me anyway) and nursing under an alternative set of ethics and morals, many, many late night conversations were had with friends, colleagues and patients about the rights and wrongs of healthcare “rules”. 

Some of the differences were stark.  I think that maybe under a Judaeo-Christian tradition, in which I was raised, there is an acceptance of the need for a certain quality of life – an idea that balances the need for futile on-going medical intervention.  This is not an idea about the costs of healthcare, more simply that there ought to be ceiling at which point further active intervention stops and the patient is allowed to die.  My Saudi (and Islamic) colleagues found this to be a rather heartless philosophy – how could one stop treatment when life was still present – when there was still hope?  The arguments were wide ranging and often vocal (but always good humoured) and helped me to develop a fascination with the ethics and morals to be found at life’s edges.

Back in England, and taking this interest to almost obsessive level, I decided to leave nursing for a while and take up law.  I enrolled at my local university (“go Teesside!!”) as a mature student, and three years later was awarded my LLB (Hons) (so proud!).  I concentrated on reading around medical law and my dissertation was on consent and capacity.

Making a go of the “no healthcare” thing, I took a temporary position with the Middlesbrough chapter of the Crown Prosecution Service, which ended up lasting two years.  I spent much of this at Teesside Crown Court, supporting Barristers and the Court as the CPS representative (similar to the Instructing Solicitor role), supporting witnesses, providing copies of documentary evidence and generally assisting with the smooth administration of justice.

My next move was probably one of the most significant episodes in my career, when I relocated from Middlesbrough to Croydon to work for the charity Action against Medical Accidents.  With a staff body of only 25 people, this tiny national charity certainly punched well above its own weight.  While my law degree told me of the cold hard law of clinical negligence, it was with AvMA that I learned how to apply that knowledge, the obstacles that lay in wait for the unwary and the challenges of funding that could prevent justice from being served.  I stayed with AvMA for seven years and moved to further my growing interest in healthcare regulation to the Royal Free Hospital, to work with complaints initially and latterly, risk and governance.

My latest position was with Lewisham and Greenwich NHS Trust, managing their CQC project, putting into practice everything I have learned thus far about medicine, nursing and the finer detail of running a hospital

Next time, I want to give a brief history of the Care Quality Commission and healthcare regulation in the UK.