The Care Quality Commission (CQC) has launched a three-year plan for co-ordinated quality regulation of integrated NHS and social care.

The strategy creates roles for three new chief inspectors: one for hospitals, one for social care and one for integrated care.

It also outlines the new appraisal system for health and care providers, based on four Ofsted-style ratings: outstanding, good, requires improvement and inadequate.

Responding to recent criticisms of its performance by the Health Select Committee and in the Francis report, the CQC has appointed a new Chairman and Chief Executive and taken on another 200 inspectors.

The three-year plan aims to ensure more extensive inspections and clearer information for patients on the safety and quality of providers.

“This is an important moment for the CQC,” said Chairman David Prior. “We have recognised we need to change and are determined to do so swiftly.”

Mike Farrar, Chief Executive of the NHS Confederation, commented: “It is clear the CQC is working hard to regain the confidence of the NHS and the public.

“This strategy shows a strong commitment to developing a system that is responsive, specialist in its sector and provides people with the information they need about the services they use.”

The NHS Commissioning Board, the ‘quango’ entrusted with managing the new NHS, will be known as NHS England from 12 April 2013.

The new name, according to Chairman Professor Malcolm Grant, is intended to represent a more “public-facing” organisation that represents the NHS as a whole.

Health Secretary Jeremy Hunt has approved the change of name, noting that its only purpose is “ensuring effective communications with the public”.

Grant’s letter to the Health Secretary outlined two “key benefits” of the Board’s new name:

• “To connect more readily with patients and the public” – thus helping to establish its support for “openness and transparency”.

• “To speak for the NHS” – thus underlining its role as the authoritative source on “NHS delivery and performance”.

Grant also highlighted the need for NHS England to maintain “presentational consistency with Government policy” – an important qualification of the ‘autonomy’ of the new NHS.

In his reply, Hunt observed that “the Board will have a critical role in communicating effectively with the media”.

He also noted that the Care Quality Commission (CQC) will have “an increasingly important and powerful role in the system in assessing the quality of providers”, and will work in partnership with NHS England.

The Board is committed to minimising the costs of the rebranding.

The Care Quality Commission (CQC) should use a ratings system like the Ofsted system for schools, according to a Government-commissioned expert report.

The new ratings system could be applied to GP practices and social care services within two years, and later to hospital services.

Think tank the Nuffield Trust emphasised that the system should be “sector-led” and allow input from patients, making it a key facilitator of patient choice.

This would not be a revival of the previous government’s ‘star ratings’ for hospitals, which were abolished in 2004 as being narrowly target-driven.

The BMA has praised the report’s commitment to appraisal of hospital services rather than entire hospitals.

The Nuffield Trust review, commissioned by Health Secretary Jeremy Hunt, said the CQC could develop the new ratings system given “stability from disruption over a period of time”.

There is “a clear gap” in the existing NHS performance appraisal system, the report said: no process exists to give patients clear information about the quality of available care providers.

Presenting the report, Nuffield Trust Chief Executive Jennifer Dixon (pictured) said ratings systems for GP practices and social care could be introduced within two years – but for hospital services, which would require individual department and clinical service ratings, more time would be needed.

The previous ‘star rating’ system for hospitals, used to help them qualify for Foundation Trust status, did not accurately reflect care quality, Dixon said.

The report emphasised that the new “sector-led” ratings system needed to be integrated with existing appraisal systems, and that the CQC would need support from other NHS stakeholders to develop and implement it.

Sources for the ratings could include QOF indicators (for general practice), hospital records, patient and staff surveys and inspections.

Sir David Nicholson, Chief Executive of the NHS, could be charged with corporate manslaughter in a private prosecution over Stafford General Hospital.

A member of the public has applied to Camberwell Green Magistrates’ Court for permission to charge Nicholson with corporate manslaughter and misconduct in public office, as well as perverting the course of justice.

Alan Edwards of Greenwich, London, a former investment banker, seeks to convince the court that Nicholson has a prima facie case to answer – i.e. that his guilt is plausible on the known evidence.

Edwards hopes to call on witnesses including members of the Cure the NHS campaign; CQC board member Kay Sheldon and former CQC investigator Heather Wood; and patient groups representing families.

“The regulatory system is just not fit for purpose,” he said. “That is why I am doing this and because there are serious failings across the health system which means things like deaths are covered up.

“We will seek full disclosure of all correspondence with David Nicholson’s office to find out about all of the information he received, what information he had and what he did with that.”

Nicholson has already claimed that the Labour government’s infection control and waiting time targets were responsible for the deaths because they distracted healthcare professionals from care quality.

Legislation allowing prosecution for corporate manslaughter was passed in the UK in 2007.

Private prosecutions for serious crimes are rare in the UK, though precedents exist. It is not clear whether Edwards will be cleared to bring the prosecution.

The Department of Health commented: “We see no basis for this case.”

The public enquiry report on preventable deaths at Stafford General Hospital has placed emphasis on improving the ‘transparency’ and regulation of the NHS.

The long-delayed report by Robert Francis QC recommends bringing together economic and care quality regulation.

However, it does not – as had been predicted – recommend that the NHS have the power to take back Foundation Trusts into public ownership.

In addition, it blames the breakdown of care at Stafford Hospital, which caused 400 to 1,200 preventable deaths, on a “systemic” failure rather than calling for leaders to be held responsible.

The Staffordshire-based organisation Cure the NHS said it would continue to campaign for the dismissal of those who “covered up” the scandal, including NHS Chief Executive Sir David Nicholson.

The scandal of poor care at Stafford General Hospital between early 2005 and early 2009 has been called the most serious failure of care standards in NHS history.

The local PCT, the Healthcare Commission and the Royal College of Nursing all denied that anything was seriously wrong. Only local campaigners kept the number of deaths and the suffering of patients in the public eye.

During an extended phase of patient neglect that Francis calls “appalling”, Mid Staffordshire NHS Trust gained Foundation Trust (FT) status.

The first enquiry in 2010, which was internal to the NHS, concluded that a “chronic shortage” of nursing staff caused by the hospital’s drive to meet the financial conditions to become an FT was the main cause of the problems.

It also noted the severe negligence implied by persistent failures to provide “the most basic elements of care” to patients in terms of hygiene, pain relief, feeding and hydration.

The Labour Government twice refused to open a public enquiry into the Mid Staffs scandal, but the Coalition Government did so in 2010.

In May 2011, Nicholson warned that the Francis report would conflict with the direction of NHS reform: it would recommend the unification of Monitor with the Care Quality Commission (CQC), when their roles were being moved further apart; and it would recommend that the NHS take back FTs that failed to maintain care standards, when FT status was being made obligatory.

The 12-month delay in the publication of the Francis report may be linked to these issues – certainly, the recommendation concerning FTs has been dropped. While the joining of Monitor with the CQC is still recommended, it appears unlikely given that Monitor is now concerned only with enforcing competition.

Other recommendations in the Francis report include:

• A “duty of candour” towards patients and the public for all healthcare organisations, including a ban on gagging clauses and a requirement to publish all upheld complaints on the organisation’s website.

• Only registered people may care directly for patients.

• The CQC should develop a team of specialist hospital inspectors.

• GPs should be responsible for monitoring secondary care services received by their patients.

Health Secretary Jeremy Hunt has said that “the crisis in standards of care” is the single greatest problem facing the NHS. However, how the recommendations of the Francis report can be integrated with the market agenda of the NHS reforms – for example, how the “duty of candour” compares with the commercial confidentiality insisted on by independent health providers – remains to be seen.

The Care Quality Commission (CQC) has warned 26 NHS provider organisations that they are not employing and training enough staff to operate safely.

A total of 17 NHS hospitals, eight mental health trusts and one ambulance trust have been recorded as non-compliant with staffing level regulations following CQC inspections up to 9 January 2013.

This represents an improvement on the figure up to March 2012, when 40 NHS providers were recorded as dangerously under-staffed.

The warnings – made public following a request from Shadow Health Secretary Andy Burnham – related to lack of staff training as well as numbers of staff.

The following providers have been warned by CQC about the dangers posed by their under-staffing:

• Hospitals – Scarborough Hospital; Milton Keynes Hospital; Royal Cornwall Hospital, Truro; Walton Centre, Liverpool; Queen’s Hospital, Romford; Stamford and Rutland Hospital, Stamford; Southampton General Hospital; Croydon University Hospital; Bodmin Hospital; Northampton General Hospital; St Peter’s Hospital, Maldon; Queen Mary’s Hospital, London; Chase Farm Hospital, London; Westmorland General Hospital, Cumbria; Pilgrim Hospital, Lincolnshire; St Anne’s House, East Sussex; Princess Royal Hospital, West Sussex.

• Mental health trusts – Ainslie and Highams Inpatient Facility, London; Campbell Centre, Bedford; Forston Clinic, Dorset; Cavell Centre, Peterborough; Bradgate Mental Health Unit, Leicestershire; Avon and Wiltshire NHS Mental Health Trust; Blackberry Hill Hospital, Bristol; Park House, Manchester.

• Ambulance trust – London Ambulance Service.

The list reflects the extent to which the ‘lean’ corporate paradigm has penetrated NHS organisations.

Health Secretary Jeremy Hunt commented: “There can be no excuse for not providing appropriate staff levels when across the NHS generally there are now more clinical staff working than there were in May 2010 – including nearly 5000 more doctors and almost 900 extra midwives.”

However, Burnham drew attention to the lack of hospital nurses: “Nurses will not be able to provide the standards of care we all want to see when they are so overstretched and the wards so short-staffed.”

Some hospitals have challenged the inspection reports. The Bradgate Mental Health Unit’s Chief Executive, John Short, said: “The temporary absence of non-nursing therapeutic staff when the CQC conducted its inspection did not and does not relate to patient safety.”

In addition, the Royal Cornwall Hospital and the Bodmin Hospital both noted that more recent CQC inspections had found their staffing levels acceptable.

The new chairs of the National Institute for Health and Clinical Excellence (NICE) and the Care Quality Commission (CQC) have been confirmed.

Following the announcement of David Haslam and David Prior as the Government’s preferred candidates for the two roles, both have been approved by the Health Select Committee.

New NICE chair David Haslam (pictured) is currently National Clinical Adviser to the CQC and chair of NICE’s Evidence Accreditation Advisory Board.

Haslam is a former GP, BMA president and chair of the Royal College of General Practitioners. His appointment can be seen as an attempt to give the GP profession a clearer voice in the NHS.

He will replace Sir Michael Rawlins, chair of NICE since its inception in 2000, in April 2013 – when NICE will extend its remit to social care.

Health Secretary Jeremy Hunt said that Haslam “will bring to this important role a wealth of skills and experience from his distinguished career as both a front line GP and a respected clinical leader.”

David Prior, who will take up the post of CQC chair at the end of January, is currently chair of Norfolk and Norwich University Hospitals NHS Foundation Trust.

He is a former Conservative MP for North Norfolk, and his appointment represents a consolidation of the NHS reform agenda.

Hunt commented: “David brings a wealth of experience to this significant position, as the chair of a foundation trust, a large comprehensive school, and experience in the private sector.”

Prior said: “I do not underestimate the scale of the challenge ahead but look forward to working with the chief executive, David Behan, and the whole of the organisation to ensure CQC is absolutely clear to the general public about the quality of services it inspects: when services are good and when they are not.”

The Government’s preferred candidate for the role of Chairman of the Care Quality Commission was a Conservative MP from 1997 to 2001.

David Prior lost the North Norfolk seat to Lib Dem candidate Norman Lamb, who is now a Health Minister.

However, Prior – whose father, Jim Prior, was a Tory Cabinet Minister – has promised that the CQC will be “completely independent”.

He identified his main priority as early intervention where care is failing: “A key role for the CQC is to spot difficulties very early so that we never have a Mid-Staffs type situation or a Winterbourne View happening again.

“From a regulator’s point of view, it is very important to act extremely promptly and have the risk analysis available and up to date all the time, so you can head some of these things off at the pass.”

A qualified barrister, Prior has also worked in the steel industry and is Chairman of the Norfolk and Norwich University Hospital NHS Trust.

Speaking to the parliamentary health select committee, Prior said that CQC inspectors needed to be mindful that NHS and social care organisations had to meet both clinical and financial priorities.

“We can do an inspection on a Monday and find that the care given in a care home is terrific, but then they go bust on a Tuesday,” he commented.

“If you go back to the predecessor organisations of the CQC, they were focused more on governance, structures, and leadership and less on outcomes. I think you’ve got to do both.”

Using more specialist inspectors rather than generalist ones might be part of the solution, he argued.

QIPP is trumping NICE as the driver of local prescribing decisions, with price ranked above value, the parliamentary Health Select Committee has been told.

Witnesses representing healthcare providers, patients and the pharmaceutical industry told the MPs that local commissioners are still restricting patient access to NICE-recommended treatments.

The ‘grey area’ between two conflicting agendas, cost-cutting and innovation, was highlighted as a cause of confusion among decision-makers.

Laura Weir, chairwoman of the patient coalition group Patients Involved in NICE, noted that despite patients’ legal right to receive drugs approved by NICE, the implementation of guidance was often blocked or delayed at local level.

“Currently there is no scrutiny or monitoring of NICE approved medicines, and there’s no one body that is responsible,” she said, arguing that the Care Quality Commission (perhaps together with Monitor) could help the NHS Commissioning Board to monitor that aspect of CCG work.

Stephen Whitehead (pictured), ABPI Chief Executive, pointed to the conflict of priorities: “Although often there will be medicines that go on the formulary, there is often not the freedom of the healthcare professional to prescribe the most appropriate medicine for that patient.

“This has been explicitly recognised by government through the publication of Innovation, Health and Wealth, which says the uptake of NICE medicines is a problem in the UK.”

Linda Patterson, Clinical Vice President of the Royal College of Physicians, highlighted the key issue: “There is an issue about implementation, which is partly about practice and the clinical decision maker implementing the guidance or not.

“On wider implementation, that is a debate about how we encourage good practice to be implemented across the country without variation. At the moment, there is a rather grey area as to who is responsible.”

The quality of care in England’s hospitals and nursing homes is suffering due to poor staffing levels and pressure on resources.

In its first general report on hospitals and social care facilities, the Care Quality Commission (CQC) has warned that one in four care services are failing.

The most common failings were in relation to staffing, workforce skills and the welfare, nutrition and dignity of patients.

The regulator noted that financial pressures were resulting in hospitals and nursing homes being systematically under-staffed, with the result that care was not focused on the needs of the patient.

David Behan, CQC Chief Executive (pictured), commented: “Health and care services need to rise to the challenge of responding to the increasingly complex conditions suffered by our ageing population. That means delivering care that is based on the person’s needs, not care that suits the way organisations work.”

The CQC report follows reports that many hospital trusts are failing to meet financial targets and facing potential closures or takeovers.

Showing the other side of the coin, the quality and safety regulator’s findings echo the warnings of the Mid Staffordshire enquiry.

The report covered 291 health and social care providers of all types except GP services, which it will report on in 2013.

Of the providers inspected, the following had failed on at least one standard of care: 22% of NHS hospitals, 19% of private hospitals, 28% of care homes and 12% of dental practices.

In private hospitals, the CQC observed, the most serious failings related to mental health and learning disabilities.

One in six NHS hospitals (16%) lacked adequate staff levels, resulting in poor drug management and record keeping.

In addition, 15% of NHS hospitals did not meet the personal and dietary needs of elderly patients, while 10% did not respect their dignity.