25th October 2013 

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News and Comment from Roy Lilley

"Patients at risk in one in four NHS hospitals.  The Care Quality Commission has placed all 161 NHS trusts in England in one of six 'risk' bands.... based on 150 indicators on the quality, safety and effectiveness of care.  In all, 27% are in the bottom two bands...."


This is the breakfast time news for the 1,579,289 readers of the Daily Mail.  They might ask; '... as the NHS has been inspecting for quality since 1999, how come a quarter of hospitals are still no place for your granny?'  Ouch!  Answer came there none. 


The risk-list is part of the CQCs latest wheeze to look busy.  'Intelligent Monitoring'.  The idea is to bash together various data and turn it into a number to rate 'risk'.  This is not new and it's not very intelligent.  The idea is based on an internal tool that the CQC has used for ages; Quality & Risk Profiling.  It is very unreliable but in fairness, might, in some circumstances, be a wet string in a breeze.


Critics say its accuracy depends on the precision of the component data, how it is modelled and calculated, weighted and factored.  Not all indicators apply to all Trusts, proportional scoring is tricky and the rules for identifying risk are arbitrary.  There are a lot of interfaces that can distort the outcome.


The CQC understood that and used it as an internal indicator along with local intelligence and information.  So, I'm puzzled; why, now, would they allow, at best, tentative data to be published in a league table style format and end up on the front pages of the national newspapers with every headline short of 'List of Death Hospitals'.... surely, only a matter of time.


I'm also curious to know why Deep-Diver Mike Richards would put his name to it?  I bet Bruce Keogh wouldn't.


The CQC is a deeply troubled organisation.  Mired in legal disputes with aggrieved former staff, overwhelmed by its task, it is struggling to make sense of the future.  A highly political appointment in the Chair (I'm told he checks with the SoS and Downing Street daily.  Personally I don't believe that.  I think it is hourly), means few are confident that it is truly independent of government.


The CQC started as (CHI) a 'learning organisation'.  Next came 'light touch'.  Later it became 'a regulator' and now an Inspector.  However, the complaints about poor care still roll in.  I wonder what it will do next?  Examiner, superintendent, Krankenhaus Kontrolleur.  Will it change the rules; for every 10 nurses employed, three overseers must be engaged.  For every doctor, two supervisors.  One to supervise the doctor and one to supervise the supervisor.   Are we moving to a time when the inspector patient ratio is more important than the nurse patient ratio?


"Inspections are costly and unreliable - and they don't improve quality, they merely find a lack of quality. The answer is to build quality into the process from start to finish. Don't just find what you did wrong - eliminate the "wrongs" altogether."


This quote is from Edward Deming's 14 point philosophy for total quality management written in the mid-80's.  Every guru since has agreed; inspection don't work!  Is it institutional arrogance that prevents Deming from applying to the CQC?


So, I am puzzled.  Why does government persist with CQC inspections and intelligent men and women belittle themselves by working at the task?


It has been whispered to me; '...there is no reason unless the real motive is to secretly welcome failure.'  To persistently look for and highlight NHS short-comings as part of a wider plan to portray it as a failing organisation, break it up and sell it.  I refuse to believe that but I know there are an increasing number of you who do.  I think it would be lunacy and an act of national vandalism.


At stake is not only a world class service but the prize of organisational morale.  Great organizations generally have high morale. When morale is high, the employees have more energy and greater focus on achieving the organisation's goals. When morale is low, employees have less energy and spend more of their time complaining, overlooking their real task, looking for other jobs and simply trying to protect themselves... is this starting to have a familiar ring to it?


The CQC, in pursuit of its Sisyphus task, is misleading the public, a threat to NHS moral and a hazard to patients... a risk of its own making.  Time for a rethink.  

Have a good weekend.


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