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Everyone says it…
… the Einstein quote;
‘The definition of insanity is doing the same thing over and over again and expecting different results…’
There's no point in quoting it over and over again coz... he didn’t say it. The phrase first appeared in the early 1980s, within the text of addiction recovery programmes.
Whatever… park that for a moment and let me introduce you to some numbers.
Here goes.
If you did something over 130,000 times since 2009 and it cost ~£3bn and it didn’t produce much of a result, do you think it would border on insanity to keep doing it?
What am I talking about?
The numbers are my rough workings on the number of inspections and assessments the CQC has carried out since its inception in 2009 and their all-up running costs.
Please keep that in mind.
Now, I want to switch your attention to the CQCs latest annual report; The State of Care, published last week.
It's very good.
It takes head-on, issues such as rising demand, constrained capacity, workforce pressures, inequalities. It frames these as systemic, long-term. Not just episodic or local failures.
It warns… the risk of erosion in care standards.
Implicit and sometimes explicit, is a sense… without intervention or reversal of trends, the quality of care may degrade further, particularly in community, primary, mental health and social care settings.
We know that but… but it’s a bit like the recent Darzi report, telling us the state the NHS is in… it makes it ‘official’.
In fairness the CQC also highlights examples of good or outstanding care, innovation and…
… resilience...
...I always think, if ‘resilience’ has to be-a-thing in the workplace, there’s something wrong with the workplace.
The CQC tells us we are at a critical juncture...
.. irreparable damage to quality, safety, dignity and equity in care. Giving the impression the system is on the brink of being unsalvageable and already in structural failure.
We’re left with only one question; the clue is in the title of the organisation...
... 'care quality'. If quality is going down the toilet...
... what's the point of the CQC? What have they been doing since 2009 and spending £3bn of the taxpayers hard earned?
Does the CQC have enough oversight, insight and influence not just to identify risk but to contribute to the reversal of decline?
The answer is obviously, no…
… yet they will still turn up after the event, clipboard in hand, writing up what everyone already knows. It’s reactive, not predictive. Descriptive, not decisive and in 2025… absurd.
Since 2009 NHS services, access, quality have all declined. The reasons are multifactorial but the decline is undeniable. The CQC have done nothing to sustain standards or improve them.
You have to ask; is there something better to spend three billion quid on?
By the way… some care home providers have not been inspected for years and 60 % of home-care providers had not been inspected in 4+ years.
An independent review by NHSE chair, Penny Dash found ‘significant internal failings’, lack of clinical expertise among inspectors, inconsistent assessments…
… the CQC are no more useful than a pedestrian on a motorway bridge watching a pile-up on the M25.
What to do?
No one serious about modern management would trash their career by working there.
Scrap the CQC and start again. Replace them with the NHS Data Forecasting Service and measure six things in real time;
1.Workforce Stability and Morale
Staff turnover, vacancies, agency reliance, sickness absence and staff survey results.
2.Leadership and Governance Stability
High turnover or weak leadership correlates with every CQC downgrade in the last decade.
3.Financial Stress
Overspend, rising agency costs, liquidity warnings and repeated non-recurrent savings targets.
4.Patient Flow and Access
Persistent and increasing breaches of A&E/RTT targets, delayed discharges, cancelled operations, high bed occupancy and complaints.
5.Safety and Incident Trends
Rising serious incidents, ‘never events’, medication errors and whistleblowing or Freedom-to-Speak-Up reports.
6.Population Health and Geography
Health Index scores, deprivation, chronic disease prevalence, life expectancy gaps, and recruitment difficulty linked to location. Coastal, rural and post-industrial areas are especially vulnerable
Six data points to track which will give us the opportunity to spot problems in the making and the opportunity to make a phone call…
‘… Hello! We can see you’ve got problems coming down the track… we are on the way with some help.’
Three billion quid? I don’t think so. We could do this with a laptop and a Cloud connection...
... from a room above the chip shop.
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