The future of regulation and governance.

The NHS in England is undergoing considerable structural change as it introduces more locally accountable hospitals, greater patient choice, payment by results and local general practitioner based commissioning of services. To deliver the anticipated service improvement associated with these changes, there is a need to ensure that the reformed NHS provides incentives for service improvement, while at the same time maintaining consistency in access to services and the safe delivery of services. The UK government is committed to reducing bureaucracy, which is based upon the associated desire to reduce the overall costs of regulation, while increasing the accountability of health services. This requires a new approach to regulation, balancing a standardised concept of quality with incentives to encourage local innovation in service design and delivery. Accountability through regulation brings with it the burdens of supplying information for audit and inspection, which are placed upon the organization. This article examines the issues that need to be considered in the design of an effective regulatory system; one that must operate within a restricted cost envelope, and in particular focuses on the concept of reducing the administrative burden associated with both inspection and self-assessment and the need to make these proportionate to a demonstrable contribution to the improvement in regulation and the ultimate goal of improvement in quality of healthcare.