The health secretary, Jeremy Hunt, raised the prospect of hospital super-heads and a new chief inspector of family doctors, in his first public response to the Francis report on hundreds of needless deaths at Stafford hospital.
Hunt told delegates at a conference hosted by the pro-competition Reform thinktank that care and compassion could not be "commanded from on high either by regulators or politicians".
He said there was regulatory madness in the NHS. "The chief executive of one of our best teaching hospitals who worked out it would take her 38 hours a week to attend all the external meetings she is asked to go to, most of which have nothing to do with patient care. Foundation trusts report having 60 different regulatory, licensing, commissioning and public scrutiny authorities to report to and comply with."
The health secretary announced that Mike Farrar, chief executive of the NHS Confederation, would draw up a plan for "how joint inspections and shared information can improve clinical outcomes and free up more time to care".
A single chief inspector of hospitals would be "primus inter pares" – first among equals – among regulators, Hunt said. "We are not short of data in the NHS. [The inspector will be] looking at the available data … to make judgments about whether there's a problem in [a particular] hospital. Taking a view that the public can understand."
Making an explicit comparison with the education inspectorate Ofsted, Hunt acknowledged hospitals were more complex than schools, but said: "The most significant reform of schools was in 1991 when the government encouraged Ofsted to declare schools were failing. That led to a generation of super-heads … who we later turned to to solve the problem of failing schools."
He said "a number of other parts of the system" would need chief inspectors to rank their services, including GPs. "On primary care we need to think about that. The one part most right for early charge is the residential care home sector … It is easier than a hospital to go into a residential care home and smell the coffee. Ask whether it cares for people, talk to residents and families."
The Care Quality Commission reports on Tuesday that a quarter of home care providers, who send nurses to help elderly and vulnerable people, are failing to meet all five national standards of quality and safety.
Hunt rebutted the central thrust of the Francis report, which made 290 recommendations, many of which would require new laws and regulations. The health secretary said he wanted to avoid the "elephant trap" of more regulation.
Robert Francis QC, author of the report, told MPs earlier on Tuesday that NHS personnel involved in poor care and unnecessary patient deaths could potentially face criminal charges.
He told the health select committee that given the evidence he uncovered during his two inquiries, he felt some staff could be charged with "individual manslaughter" or "offences in relation to wilful neglect of vulnerable people".
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