The NHS needs to be an organization in which an open dialogue about care quality is part of the natural culture of the organization, not a duty which only arises in cases of service failure. Robert Francis made 290 recommendations in his report, but in truth they boil down to just one - that the culture of 'doing the system's business' is pervasive in parts of the NHS and has to change. Many who raise their concerns in the NHS at present risk serious consequences for their employment and professional status. But disciplinary procedures, professional conduct hearings and employment tribunals are not the proper place for honestly-held concerns about patient safety and care quality to be aired constructively. The NHS standard contract imposes a duty of candour on all NHS providers. This is an essential principle, but it is not adequately understood or applied. It should mean that all providers create a culture which is routinely open both with their patients and their commissioners. The same principle should apply to commissioners so that they are routinely open and accountable to local communities. The Health Committee recommended this approach in 2011 and repeats that now. It should be a prime role of the CQC to encourage the development of this culture within care providers, and of NHS England to develop the same culture within commissioners. The Health Committee will in future work closely with the Professional Standards Authority to develop the accountability process for professional regulators in healthcare

A draft Law Commission Bill on the regulation of health and social care professions sets out the framework for a negative register, but it was not included in the Queens' Speech either as a draft or a substantive Bill. The Government needs to set out what changes to the powers of regulators it is planning to make through secondary legislation instead. Following up themes in the Francis report, regulators need to be visible and accessible to registrants, and also to patients and members of the public who wish to raise concerns about patient safety. Since 2003, the HCPC has recommended that statutory regulation be extended to a further eleven professions from the current sixteen. Of these, the only groups to receive statutory regulation to date are operating department practitioners and practitioner psychologists [the other groups are Clinical Perfusion Scientists, Clinical Physiologists, Dance Movement Therapists, Clinical Technologists, Medical Illustrators, Maxillofacial Prosthetists & Technologists, Sports Therapists, Sonographers and Genetic Counsellors]. The HCPC should list any professional groups for which they feel there is a compelling patient safety case for statutory regulation so that this can be pursued with the Department of Health as a matter of urgency. There is also concern at the length of time it can take for professional groups to gain statutory regulation. Given that new groups can be added to the HCPC's register by means of secondary legislation, there should be no undue delay in extending statutory regulation to professional groups where there is a compelling patient safety case for doing so

An in-depth analysis of the NHS reforms ushered in by UK Coalition Government under the 2012 Health and Social Care Act. Essential reading for those studying the NHS, those who work in it, and those who seek to gain a better understanding of this key public service.

This year's inquiry into the work of Monitor concludes that the model of care provided by the health and care system is not changing quickly enough with the result that pressures continue to build, threatening the financial stability of individual providers, and therefore the quality of care provided The pressures are likely to be particularly marked in the acute sector as plans are prepared and implemented to achieve the resource transfer required by the introduction of the Better Care Fund from April 2015. Continuing this theme, the Committee argues that as the NHS financial situation tightens, the challenge for Monitor in supporting trusts in financial difficulty is likely to increase. The MPs emphasise the importance of addressing pressures within individual providers in the context of the local health economy. The requirement for major change in the care model can only be delivered if individual providers, and Monitor as their regulator, look beyond preserving existing structures and address the need to develop different structures to meet changing needs. The Committee also expresses concern that Monitor has not done enough to reform the system of tariff payments for providers, arguing that the current tariff arrangements often create perverse incentives for providers and inhibit necessary service change. It recommends that Monitor and NHS England should initiate a formal joint process for a prioritised review of the NHS tariff arrangements with the objective of identifying and eliminating perverse incentives and introducing new tariff structures which incentivise necessary service change

In April 2010 Dr David Bennett was appointed as interim Chief Executive of Monitor and then as Chair in March 2011. He was appointed permanent Chief Executive of Monitor with effect from 1 November 2012, while remaining as Chair pending a new appointment. On 10 October 2013, the Secretary of State proposed to appoint Dominic Dodd as Chair of Monitor. Dr Bennett has filled the roles of both Chair and Chief Executive - effectively Executive Chair - and has led Monitor through the whole process of change brought about by the Health and Social Care Act 2012. He has both shaped and interpreted the role that Monitor now plays in the system which makes the transition to another individual taking on the Chair an especially difficult one. On this basis the Committee did not endorse Mr Dodd's appointment

In this report the Health Committee welcomes improvements in the performance of the Nursing and Midwifery Council (NMC) over the last year, but expresses continuing concern that the progress made so far remains fragile. The Committee emphasises that it is important to ensure that the new challenges facing the NMC do not become a distraction from the continuing requirement to improve its performance of its core functions. The report is the first example of a Health Committee review of a professional regulator which builds on the work of the Professional Standards Authority (PSA). The length of time the NMC takes to conclude its fitness to practise cases has been an enduring concern for the Committee. From 2015, the NMC proposes to toughen the target period for resolving fitness to practise cases to 15 months (eventually to 12 months). The NMC has announced plans to introduce a system of revalidation by the end of 2015 which is welcomed. The Francis Report into the failings at Mid Staffs examined the role of regulators, including the NMC, in detail. The report stresses the importance of ensuring firstly that registrants understand their professional obligation to raise concerns when they see evidence of poor patient care, and secondly that patients and public are made more aware of the role of the NMC as the regulator of professional and clinical standards. The NMC should take urgent steps to raise the profile of the NMC both among its registrants and among patients and public.

This book offers a global perspective on healthcare reform and its relationship with efforts to improve quality and safety. It looks at the ways reforms have developed in 30 countries, and specifically the impact national reform initiatives have had on the quality and safety of care. It explores how reforms drive quality and safety improvement, and equally how they act to negate such goals. Every country included in this book is involved in a reform and improvement process, but each takes place in a particular social, cultural, economic and developmental context, leading to differing emphases and varied progress. Methods for tackling common problems - financing, efficiencies, effectiveness, evidence-based practice, institutional reforms, quality improvement, and patient safety initiatives - also differ. Representatives from each nation provide a chapter to convey their own situation. The editors draw a conclusion from these numerous contributions and synthesize the themes emerging into a coherent ‘lessons learned’ summary that delivers value to the numerous stakeholders. Healthcare Reform, Quality and Safety forms a compendium of the current ‘state of the art’ in global healthcare reform. This is the first book of its type, and offers a unique opportunity for cross-fertilization of ideas to the mutual benefit of countries involved in the project. The content will be of interest to governments, policymakers, managers and leaders, clinicians, teaching academics, researchers and students.

This best-selling textbook covers the essential topics of undergraduate public law modules in an insightful and interesting way. The authors capture the vibrant nature of public law in practice and the key contemporary debates in the field.

Diet, obesity, and physical activity all have important impacts on health. For too long however, physical activity has been seen merely in the light of its benefits in tackling obesity. A core message from this inquiry is the compelling evidence that physical activity in its own right has huge health benefits totally independent of a person's weight. The importance of this - regardless of weight, age, gender or other factors - needs to be clearly communicated. Interventions focused on encouraging individuals to change their behaviour with regard to diet and physical activity need to be underpinned by broader, population-level measures. Whilst both are important, population-level interventions have the advantage of impacting on far greater numbers than could ever benefit from individual interventions. The Committee recommends that the next Government prioritises prevention, health promotion and early intervention to tackle the health inequalities and avoidable harm resulting from poor diet and physical inactivity. The Committee regards it as inexplicable and unacceptable that the NHS is now spending more on bariatric surgery for obesity than on a national roll-out of intensive lifestyle intervention programmes that were first shown to cut obesity and prevent diabetes over a decade ago. All tiers of weight management services should be universally available and individual clinicians should use every opportunity to help their patients to recognise and address the problems caused by obesity and poor diet, and to promote the benefits of physical activity.

15 million NHS patients in England with long-term conditions such as diabetes, arthritis and asthma account for 70% of the annual expenditure of the NHS in England. One projection estimating that the bill for treatment of long-term conditions will require the NHS to find £4 billion more each year by 2016. Increasingly, patients do not have a single long-term condition but live with two or more conditions, complicating treatment and adding to its cost. The Committee strongly supports the development of individual care planning for people with long-term conditions, based on the principles successfully demonstrated in the NHS House of Care programme. Care planning approaches will involve GPs, community health services and specialists sitting down with the patient to draw up a personalised plan for the care required, which includes the support needed to help the patient manage his or her own condition. The challenge, though, of introducing personalised care planning for 15 million people is substantial. The Committee looked at the prevailing view that services to treat long-term conditions should be moved out of hospitals and into primary and community care. To provide effective care for these conditions, services have to be maintained across all settings, from support in the home through to acute specialist care, and many conditions will continue to require specialist services delivered in hospital. Effective management of long-term conditions also requires collaboration with other government providers, such as housing and transport services.