The claim: “The NHS Confederation has counted 698 auditing standards and 69 different auditing bodies” - Guardian editorial, 9 November.

Background

This week an enquiry begins into what can be done to rectify the sorts of failings notoriously uncovered by last year's investigation into Mid-Staffordshire NHS Trust. With it has come a renewal of the discussion over how to ensure standards in the NHS.

A Guardian editorial published yesterday argued that “regulation may be part of the problem rather than part of the answer” - a conclusion drawn from the figures mentioned above.

Are there really 69 auditors imposing on the NHS? And if the NHS Confederation is regulating these so-called regulators, then who can regulate the Confederation? Full Fact stepped into the breach.

Analysis

Both of the statistics mentioned by the Guardian originated in a 2009 report, which carries the subtitle “removing unnecessary bureaucracy in regulation”.

The report examines organisations with a role in NHS regulation that fall under a broad category defined as “RAIAs”: regulators, auditors, inspectorates and accreditation agencies.

The 698 “auditing standards” mentioned by the Guardian are listed comprehensively in the report. In fact, this figure is gleaned from a sample of the information requested by only 35 “auditing bodies”, suggesting that it is if anything an underestimate.

Furthermore, when the thirteen Royal Colleges are all included individually the appendices do indeed list 69 organisations which act in at least one of these capacities in relation to the NHS.

However before this claim is given a simple pass, it is worth noting some of the context to these numbers.

A previous NHS Confederation report accepted the Department of Health's definition of “regulation” as: “exerting powers over, or imposing burdens on, other organisations or individuals; by means of inspection, licensing, referral to another decision-maker (particularly with binding advice), accreditation or enforcement.” It is not clear that all of the bodies fulfil these criteria.

Firstly, only nineteen of the bodies mentioned in this report have statutory footing. Many lack the authority to make mandatory inspections, and cannot therefore technically “impose” on the NHS.

While each may have a role in regulation, auditing, inspecting or accreditation, to label them all “auditing bodies” risks giving the impression that all of them exist solely to monitor the UK's hospitals. This does not seem quite right, since the list includes among others Ofsted, the Fire Authorities and the Environment Agency.

This may be because the Guardian's numbers can be traced to a reference to the report from its author, rather than the report itself.

And how much of a burden such initiatives as “North Central London SHA library accreditation” really place on the NHS nationally seems questionable.

But although some of these organisation's status as “auditing bodies” might sometimes be incidental, Full Fact can find no grounds for doubting that each has some role in RAIA.

Conclusion

The claim in yesterday's Guardian, then, is largely justified: the NHS Confederation has counted 698 standards measured by various RAIAs, and lists 69 RAIAs in the same report.

Whether all 69 can be described as “auditing bodies” is debatable. Care should be taken before inferring they simply represent a plethora of institutions all fulfilling the same regulatory role.

However, the NHS Confederation's findings seem legitimate, and it is legitimate for the Guardian to cite them.

Edgar Gerrard Hughes