Many of the behaviours trusts would like to see from CQC align with the principles of 'right-touch regulation' – the conceptual framework developed by the Professional Standards Authority (PSA, 2015), building on the Better Regulation Executive's work on 'good regulation' (Better Regulation Task Force, 2003). Right-touch regulation is a concept applicable to different sectors and types of regulators, as it is founded on good regulatory practice.
The right-touch regulation principles are:
- Proportionality: regulators should only intervene when necessary.
- Consistency: rules and standards must be joined up and implemented fairly.
- Targeted nature: regulation should be focused on the problem, and minimise side effects.
- Transparency: regulators should be open, and keep regulations simple and user friendly.
- Accountability: regulators must be able to justify decisions, and be subject to public scrutiny.
- Agility: regulators should look forward to anticipate change, rather than looking back to prevent the last crisis from happening again.
According to the PSA, right-touch regulation is the "right amount of regulation… needed for the desired effect. Too little is ineffective; too much is a waste of effort." Right-touch regulation recognises that there is no such thing as 'zero risk' and accepts the valid trade-offs between different risks and competing benefits. It is based on a proper evaluation of risk and creates a "framework where professionalism can flourish and organisations can be excellent." The above should be guiding principles for CQC's regulation.
Another useful concept is that of "responsive regulation", as described by Judith Healy and John Braithwaite (Healy, J. and J. Braithwaite, 2006). This refers to the use of mechanisms that are responsive to the context, conduct and culture of those regulated, and to an approach that values trust, transparency and professionalism in the relationship between the regulator and those regulated. The authors propose a regulatory pyramid that begins with "persuasion" and continues with the capacity to escalate and "punish" those regulated, should persuasion fail.
Joy Furnival and Kieran Walshe’s analysis on emerging hybridity (Furnival, J. and K. Walshe, 2017) reveals that "effective regulatory oversight relates to the ability of regulatory agencies to balance the requirements to assure and improve care". It recognises the tension between the regulatory aims of improvement, accountability and assurance and recognises the complexity, but also the benefit, of such hybrid models of regulation. The authors argue that, instead of high levels of ongoing intervention and support for improvement, "regulatory agencies could strengthen their approaches to assure and improve care by focusing on the development of improvement capability as well as seeking to ensure compliance with standards and performance within regulated organisations". This suggested approach combines support for improvement with CQC's ultimate goal to assure the public of the quality and safety of care.
Recommendation 1
We recommend that: CQC fully embraces the principles of right-touch regulation.