Tuesday, August 11, 2015

Soft touch; hard evidence

Much has been said about the role of the Care Quality Commission in recent times- a murmur has gathered pace with the Professional Standards authority questioning the role of regulation. 211 million pounds is the figure mentioned spent behind CQC and maybe its time for some sense checks, as well as for the CQC to consider the next phase of its development.

For starters, let’s be honest- nobody likes to be examined or regulated. We, hopefully, all go to work believing to be able to do the best for our patients- so any external regulation raises the question whether we are or not. Sadly, past events have suggested there probably is a need for this- and the question is whether CQC needed to exist whether all Trusts and staff had done enough with their internal processes. That’s what, perhaps, CQC needs to tackle..a step away from the criticism and be more of a guide. Shine a light but also make robust suggestions, share examples from their travels where its better. There is little point in saying “you are not good” if you can’t be a support to improve or indeed give suggestions as to how to do so within present financial constraints.
Interrogate success, not failure- that possibly needs to be how CQC functions

Secondly, I have seen CQC appear in a few Trusts- and to be fair, it has opened doors to fight the corner of patients in some cases. The name CQC has made managers sit up and listen when previous business cases, please, data has failed to do so, failed against the wall of financial imbalance. One may say that’s a culture of fear but it’s a sad indictment of internal processes where the name CQC is needed to make changes. In an irony, perhaps it makes the case more for its existence. To many, the message thus is..sort your own internal bits out..if you do, then the CQC doesn’t need to exist

Thirdly, the money involved. 211 million sounds a lot but its also about context- especially when you think that the whole NHS budget is about 110 billion. Our local 3 CCGs has a combined budget of about 800 million- so in a national context, that money released would be about 1 million/ CCG..something that would be swallowed by CIP budgets in a blink of an eye

Finally, its also about CQC learning from experience. More soft touch, less marching in. But most importantly? The need for data. Quite rightly the return of investment is asked for- as with every sector of the NHS and this is where CQC has floundered. Let me give you a simple example- CQC has examined X number of steps- as a diabetes specialist, I would like to know what diabetes specific changes have happened in hospitals to keep patients safe? Gillian Astbury was one of the deaths due to lack of insulin in Midstaffs. Has CQC inspection improved that? Anecdotally, the answer is No. Prove the doubters wrong- show that insulin prescription has improved, show that errors are less, never events are less..think of metrics, markers, maybe even simply checking whether the recommendations given in Trust Z has been implemented or not.

Indeed, there are many arm length bodies that can be amalgamated and role looked at in times of financial strife- but on balance, the CQC probably still has a role as I am yet to be convinced that internal processes are robust enough and protects patients enough. But for that CQC also needs to adapt and be ready to answer critics with data- not with simple emotions. The need to improve care sits with all of us- the trick is to move away from the emotiveness and base it on data. Let’s see whether the powers that be are ready for that.

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