The rise of regulation in the NHS

The current British government has created five national agencies to regulate the NHS. These new arrivals are simply additions to an already crowded regulatory landscape. But, if politicians can be persuaded to let go, the new regulators of the NHS could provide a genuinely new approach to improving performance and management

During the past four years the British government has created five new national agencies to regulate the NHS in England (box).1 2 3 4 The government has moved away from using markets, competition, and contracting to manage performance in the NHS. But it has been unwilling to rely on traditional bureaucratic structures to exert control, and has turned increasingly to regulation.

In this article, I describe how and why organisational regulation in the NHS in England has grown in recent years. I examine how regulation was used in the NHS in the past and describe the characteristics of the new regulatory agencies. Finally, I use information from the wider literature on regulation to examine the regulatory model adopted by these new agencies and to explore what they might learn from regulation in other settings.