6th November 2013 

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It's the people, stupid.    
News and Comment from Roy Lilley
I don't want to highlight the woes at Cambridge FT, two editions in a row.   They have enough to worry about but... this is about them... but not about them.


A reader drew my attention to a BBC story, date-lined November last year, where the hospital put a wrong implant in a patient's eye.  The mistake was rectified immediately.


The Trust was in trouble.  There were more instances of poor or untimely care.  There was also an incident with a whistle-blower who, in 2010, ended up at a Tribunal and was ruled unfairly dismissed by the Trust.  I wonder how many other members of staff might have come forward if this matter had been handled differently?  I bet they wished they'd have listened.  


So, what's my beef?  If you read the article you will see that all the remedial action, reporting and oversight was undertaken by Monitor.  Indeed, Monitor's chief operating officer, Stephen Hay, said: "This is not the first time we have called the trust in to explain itself.  We are disappointed that the board has not resolved these issues."


It's pretty clear that Mr Hay and Co is no better at sorting out quality than the CQC.  And, anyway, isn't this the CQC's job?  Who is responsible for Quality?  Is it Monitor or the CQC?  The CQC or Monitor? 


It appears I am not the only one to question the CQC and Monitor.  None other than the mighty Gooroo got in touch and pointed me to his posting.  This is a link you must follow; neither the CQC nor Monitor appears to understand 18 week waits nor the implications of what they are doing.


The muddle between the CQC and Monitor was highlighted in reports by Berwick and Francis.  In an effort to allay our fears the CQC and Monitor invented a memorandum of understanding; how they will work together - it is 23 pages!  If two organisations need 23 pages to figure out how to pick up a phone and talk to each other...  does it tell you something?   


No one wants bad quality healthcare, cack-handed management or the public put at risk.  However, to challenge the CQC or Monitor is to invite the implication that you are in some way in favour of slap-happy management.  That is far from correct.   


Somehow we have to make the the CQC face facts;  they are making it up as they go along, have no tools but a bigger clip-board, makes a mess of analysis and is losing the confidence and patience of everyone concerned.  Monitor and the load-stone of the market is an impediment to innovation and reconfiguration and as the Big-Beast has said; endangers quality.


In April last year the CQC was subject of a Performance and Capability Review.  'Defining its role' was one of its key tasks critiqued.  It was criticised for not setting out the measures of success which it aims to achieve.  Another layer of inspection by Deep Diver Richards has added complexity.  The CQC has become a bomb-shelter for Ministers hiding from the fall out when things go wrong.


Last evening the news broke that the police were being called in to Colchester General following allegations that staff were bullied into falsifying cancer care records, to meet targets.  The CQC had inspected this Trust on the 14th March this year and 12th September and 30th May last year and in 2011 in November and April.  You'd be forgiven for thinking they might have spotted something earlier, dug deeper, done more?  


For two years the RCN has been voicing concerns about Colchester and they say their representative was denounced, by the Trust, as a fantasist.  I bet they wish they had listened!   The Trust has been put into 'special measures' under the purview of Monitor.  Who is responsible for quality?  Monitor or the CQC?  The CQC or Monitor?     


The toxic cocktail of targets, savings, inspection, reputation-saving, top-down bullying, confused responsibilities and hubris is making the NHS unmanageable and dangerous.  


Inspection does not make us safer; people do.  Organisations don't care for us, people do.  People don't come to work as liars, target fiddlers and cheats; it's what organisations reduce them to.


When is the NHS going to learn; forget inspection and just listen and learn from the front-line.  It's all about the people, stupid.


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