31st January 2013 

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Show them the door   
News and Comment from Roy Lilley

I am sorry to hear the good folk at Stockport FT are having a bit of a palaver over A&E waiting times. Monitor has written to their lawyer chair and put the boot-in. Ouch! I have no idea what has happened at Stockport. A&E is a minefield. National changes are planned. Good luck is the best I can manage.


What worries me is how we got into a mess that cannot have come as a surprise to the Board. I assume they get regular reports at Board Meetings? If it looks like a target-problem is looming I would expect supplementary, interim reports. Weekly or daily? Even hourly. If the CEx is in trouble the NEDs need to roll up their sleeves and see what they can do to help. Isn't this their quality issue?


Do they have Governors? What did they do? Isn't this their quality issue?


Looking at it from the patient's point of view; hanging around in A&E is no fun. Parked on a plastic chair for four hours plus isn't good enough, even if they are there 'inappropriately'. If you are really ill, wriggling about on a trolley is no picnic either. Isn't this someone's quality issue?


Don't we have an organisation, costing millions, to deal with 'quality'? The Care Quality Commission? The clue is in the title. We have a Commission to make sure that we are seen, spit-spot, in A&E, don't we? Should Monitor write to the CQC and put the boot? Isn't this a quality issue for the CQC?


If you dig around the CQC web-site you'll see their survey of people using Stockport's A&E rates them 'about the same' as every other hospital. If this is true; shouldn't Monitor write to everyone? Are the CQC too easily fobbed off? Is the whole of the NHS an A&E shambles? Isn't this a quality issue for the quality people?


The responders to the CQC survey score Stockport's A&E reception and waiting as 6.2 out of ten. Not exactly ER, is it? Isn't this something that local GPs would have been aware of? I thought GPs were in charge of all this? I have scoured the internet and can't find a single reference.


How come GPs let a target failure slip past? How about the Local Authority or the HealthWatchers? Don't they all 'do' quality?


Who does 'do'quality? Well, now the Carbuncle is having a go. On page 50 of their latest wretched, thoroughly horrible document about a new chimera; the National Quality Board, they list ten organisations that 'do' quality. They talk about 'risk summits' and 'mechanisms to encourage the different parts of the system to come together...' groan...  


They have 23 members on their 'Board'; only three of whom are 'lay members', each involved in senior health management elsewhere and about as close to being a patient in Stockport's A&E as Bill Gates is to using my PC.


Lumping everyone together I recon the costs-in-flow around NHS 'quality' are close on �100m, yet not one penny of this confusing, overlapping, dysfunctional mess works.  Quality is everyone's business but no one's job. 


Will the NHS solve its quality problems with more referees, cop's, ringmasters, whipper's-in and adjudicators? Can it put an end to quality problems with more targets, rules, Boards, Committees, guidance and putting the boot-in? No.


Quality is only consistency; figuring out what you want and putting things in place to make sure you get it, all the time, every time until you don't want it anymore. So, whose job is it?


Monitor can wear out a pair of big boots but they can't fix anything. The CQC don't seem to know what needs fixing. GPs seem not to know what's happening in their backyard. Ten organisations on the list and the 11th the National Quality Board, can't cut waits in Stockport but I bet they'll write some stonking billet-doux.


In all instances of Trust quality-failures the people who should have known first and fixed it fast are Boards. All quality failures are Board failures. The rot is at the top. If Boards can't deliver speed, excellence and value added, show them the door.


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