Why risk-based regulation of healthcare quality in the NHS cannot succeed. HowSAFE Working Paper No.5.

This paper explores the challenges of regulating healthcare quality and explains why risk - based approaches have not - and cannot - solve the problems of governing the National Health Service (NHS) in the UK . Based on historical policy analysis and in - depth interviews with 15 high - level informants, it documents the instability and layering of ambiguous and often contested and contradictory definitions of healthcare quality in the NHS. Partly as a result regulators have also struggled to measure quality and to identify which providers are failing to meet the required quality standards , despite world - leading systems for statistically analysing the wealth of outcomes data and indicators generated by the NHS. There are also problems with applying the conventional enforcement pyramid of ‘carrots and sticks’ in healthcare because deterrence - oriented sanctions in response to non - compliance risk further undermining care quality and more compliance - oriented levers for enforcing quality standards have proven ineffective in a sector characterised by strong information asymmetries and monopolistic provision. While risk - based approaches promise to help rationalise and manage the inevitable limits of governance and what it can hope to achieve, we argue that they will inevitably disappoint so long as there is no political tolerance for failure in the NHS. Beyond these difficulties in defining acceptable quality standards and assessing how far it is reasonable to go in trying to meet them, we also raise questions about the extent to which ensuring healthcare quality in the NHS is a problem that even admits of regulatory solutions at all, give n the systemic problems of delivering a service in the context of numerous conflicting governance goals and constraints.