Patient safety regulation in the NHS: mapping the regulatory landscape of healthcare

Abstract

Objectives: The current research project sought to map out the regulatory landscape for patient safety in the English National Health Service (NHS).

Method: We used a systematic desk-based search using a variety of sources to identify the total number of organisations with regulatory influence in the NHS; we researched publicly available documents listing external inspection agencies, participated in advisory consultations with NHS regulatory compliance teams and reviewed the websites of all regulatory agencies.

Results: Our mapping revealed over 126 organisations who exert some regulatory influence on NHS provider organisations in addition to 211 Clinical Commissioning Groups. The majority of these organisations set standards and collect data from provider organisations and a considerable number carry out investigations. We found a multitude of overlapping functions and activities. The variability in approach and overlapping functions suggest that there is no overall integrated regulatory approach.

Conclusion: Regulation potentially provides a variety of benefits in terms of maintaining the safety and quality of care by providing an external perspective on the care being delivered. However, the variability, extent and fragmentation of the regulatory system of the NHS make it hard for regulators to act effectively and places a massive burden on NHS provider organisations. Overlapping regulatory requests may distract locally driven initiatives to improve safety and quality. Further research is needed to understand the full extent of regulatory activity and the true benefits and costs incurred.

Keywords: healthcare; mapping; patient safety; regulation; regulatory functions; statutory regulators.

Figure 1

Overview of healthcare regulation map.

Figure 2

Regulatory activities and definitions.

Figure 3

Regulators and organisations with regulatory influence.

Figure 4

Regulatory functions and activities. CCGs, Clinical Commissioning Groups; CQC, Care Quality Commission; EA, Environment Agency; GCC, General Chiropractic Council; GDC, General Dental Council; GMC, General Medical Council; GOC, General Optical Council; GOsC, General Osteopathic Council; GPhC, General Pharmaceutical Council; HCPC, Health and Care Professions Council; HFEA, Human Fertilisation and Embryology Authority; HSE, Health and Safety Executive; HTA, Human Tissue Authority; MHRA, Medicines and Healthcare Products Regulatory Agency; NHSI, NHS Improvement; NMC, Nursing and Midwifery Council; UKAS, United Kingdom Accreditation Service.