The Guardian has reported this morning that:
Wes Streeting has called England's healthcare watchdog “not fit for purpose” after an interim report found significant failings were hampering its ability to identify poor performance at hospitals, care homes and GP practices.
This is the second time this morning that I am forced to note Labour has apparently discovered something that everyone knew. Roy Lilley's newsletter on the state of the NHS has reported this failing for ages. Streeting should have been reading it.
So, let's mention why the Care Quality Commission (CQC) can't work.
First, that is because it has been used to blame NHS staff for the systemic failings of the NHS for most of the life of the Tory government. An organisation whose raison d'etre is to buck pass whilst ignoring the fact that NHS failings are down to political choices to deny that service the funding it needs is always going to fail, and by design.
Second, who would want to work in an organisation with that remit? Of course it is having trouble finding suitably qualified staff.
Third, it is underfunded: why work for it?
But most importantly, and fourth, quality inspections cannot and never will raise standards. That goal is achieved by providing sufficient funding and letting staff react to priorities. Quality audits presuppose a shortage of resources and, as a result, focus on organisations achieving centrally prescribed priorities, whether they are appropriate or not.
We have seen this system not just fail but cause considerable harm in schools when delivered by Ofsted. It is no better in the health service.
The reason why is simple. The logic of reorganisation of both the NHS and schools over this century has been to supposedly decentralise control to assist preparation for privatisation whilst at the same time imposing draconian central control from Whitehall, which demands its goals are met. The goals are obviously contradictory. There is an inherent conflict within the structure of schools and the NHS which no amount of inspection can overcome, most especially when it is not allowed to comment on it as a cause of failure.
We Streeting has to decide. Does he want to control the NHS, or does he want it to have operational freedom? When he can make up his mind on that (which I am not expecting any time soon), then there is a chance that standards in the NHS might improve.
But I stress that there is only one answer that is politically viable, which is central control, and only one answer which is operationally viable, which is to trust local management to respond to local situations. He will have to live with the stress, and the odd failure, because that's what happens in systems run by people.
Could Wes get his head around that? Watching his performance in interviews in the media this morning, I doubt it.
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Substitute “Enviroment Agency” & water for CQC & health – same result. The tories are/were too thick to have done this deliberately – it is an outcome of their ideology (small & shrinking gov). Either Streeting gets a grip or he will be one of the shorter lived appointments. My guess is the latter, he is a weak & stupid man & high office is exposing his shortcomings. Reeves will be next.
Get the popcorn in Mr Parr. Streeting is the Mandleson/ Blair anointed one for the ‘big job’ after Starmer. Nothing will be his fault; blame for any failings will be cast around everywhere – previous gov, nhs managers, ‘over entitled’ patients with unrealistic demands, civil servants, local gov, etc etc – and the only answer will be privatisation, digitisation and giving lots of money to ‘think tanks’ to work out what needs to be done.
Its going to be a slow motion ‘car crash’. Pull up a chair. The country voted to be powerless to stop it.
As far as I can see, not reported anywhere in the M.S.M, this week the Scottish Government announced an extra £30m for the S.N.H.S to ease waiting times. Probably not a huge amount in the great scheme of things, but at least they are trying to help people who are suffering through no fault of their own.
The BBC has broadcast questions in the House of Lords about prisons to Lord James Timpson. It was an excellent performance on a difficult and complex brief.
For instance, he has a commitment, among others, to reduce the rate of reoffending. As well as the need for more – well trained – probation officers, he pointed out that it is essential that on release, ex-prisoners need to have a home to go to.
Whatever one’s opinions of other newly appointed ministers, the Prime Minister is to be congratulated on his appointment of Timpson: personal experience, knowledge, sensitivity, thoughtfulness, intelligence, long-term commitment …
Accepted
On the CQC…
There is nothing wrong with regulation. It is no substitute for ownership but that’s another story.
It is what you are regulating for and how you go about it …
The professions regulate their members , mainly by compulsory professional education and enforcement of an ethical code.
But it doesnt work so well in weaker professions who have less ability to withstand managerial bullying.
So there does need to be external overview, scrutiny, audit and inspection.
It is especially true with organisations under financial pressure to reduce quality and take risks with other peoples lives.
The good news is that technology makes this easier. The problem is that it highlights too many issues requiring action and as a result regulators including the CQC have taken a politically acceptable subjective route of bullying the weak and being craven to the strong. Its neither fair nor just nor accurate nor constructive.
The CQC needs to exist but it should adopt a data driven approach which would target action in areas that need it most. And it should hold leaders and politicians to account for failing to take action.
I fear the attacks on the CQC are driven by some in the no regulation brigade , beloved of the free marketeers. What you get is sewage in your water, adulterated food , and unattended sick people left to die in crowded A&E and on hospital corridors.
Others of course are correct to criticise the CQC but be careful not to throw away the baby with the bathwater.
You are right to point out the method of setting up methods to distance people in positions of power from the failings of the organisations they ‘control’ — fragmentation of the management structures, outsourcing and ‘independent’ oversight bodies ,,,,, but rarely anyone’s fault, despite the rhetoric. The problem of the budgets and fear of accepting blame in the NHS (accidents really do happen in all walks of life) reduces our ability to address it.
(If we forget recent shenanigans re: Boeing) – there is a lot to be learned from the approach (previously) adopted to failure within in airline industry. Open and thorough investigations, and previously a culture of finding out the problem. We also need staff to be encouraged to be open and aim to support best practice – and to call out poor practice. It should be an obligation. We’ve seen a culture of cover up in the NHS.
Ditto the police (for as long as I can remember), local government, privatised utilities, outsourced organisations (think prisons), ….. we could go on. So the issue for Labour isn’t just about who to blame (though that’s very easy at the moment) – the real challenge to help UK PLC is to change the culture, and to support genuine improvement and management to deliver (not just to protect corporate backsides!).
Buyer’s remorse in a winning politician is a very worrying trait and does not fill one with confidence.
Someone ought to suggest to the Labour(ed) front bench if they want to consider another election if the job is too big for them.
I read the other day in Byeline Times that an even MP is on over £91K a year!
Stop whining and get on with it or get out of the way.
‘Can he get his head around it?’
Does he want to get his head around it?
Not much sign of genuine curiousity – he will say anything except ‘more money’.
And his appointment of Lord Darzi and Alun Milburn seems to signal yet more meddling and ‘restructuring’ and ‘modernising’- that politicans cannot resist – as the private sector pants nearby..
Sadly, Streeting is already turning out to be as bad as I expected, especially regarding his comments on the vote to end child poverty.
Having, towards the end of my career in Local Government, suffered the dead hand of the Audit Commission measuring everything that we did but not everything that mattered I can honestly repeat the old farmers adage of “ you don’t fatten pigs by weighing them” so let’s get some sustenance into the NHS before it succumbs altogether to starvation rations.