How does regulation work in the NHS?

Regulation helps to ensure that the NHS provides high-quality care, that finances are well-managed and that staff meet professional standards. This step explores the multiple layers of regulation in the NHS in England.

Health care systems across the world usually have a system of professional regulation. This level of regulation ensures that people can only practice as a doctor or nurse or therapist if they meet standards of good practice and abide by codes of professional conduct. In England, some of the bodies that act as professional regulators are the General Medical Council, Nursing and Midwifery Council and the Health and Care Professions Council. Doctors, nurses, midwives and allied health professionals all need to be registered with one of the above bodies in England in order to work in these professions. When health care professionals fail to meet the standards of professional conduct, they can be fined or taken off a professional register and prevented from working in this profession.

While professional regulation is common around the world, in England we also have something called system regulation. When the NHS was first founded, Nye Bevan reportedly said if a bedpan is dropped in the corridor of a hospital in Tredegar in Wales the crash should reverberate around the Palace of Westminster because he wanted ministers to be directly accountable for what goes on in the NHS. Since then, successive governments have tried to put more and more distance between politicians and the day-to-day running of the NHS, so they’ve created system regulators to fill that gap.

The main system regulators in England are the Care Quality Commission (CQC) and NHS England. CQC is an independent body that is responsible for ensuring that health and care services provide high quality and safe care. They do this by monitoring and inspecting services to ensure that they meet key standards of care. If these standards aren’t met then services can placed in special measures to improve their performance or be held to account by issuing cautions, fines or prosecuted.

NHS England focuses more on the performance and finances of NHS organisations and commissioners. NHS England has the power to directly intervene when services are failing, for example removing directors who aren’t performing well or directing an organisation on the actions that it needs to take to improve their performance. As the NHS is a publicly funded service, there is a strong public interest in making sure that it delivers a high quality of care and that NHS finances are sustainable so that people are able to access services when they need them.