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Our hospitals may be bad but our regulators are worse

Another week, another hospital scandal. The story is beginning to be all too familiar: dozens of patients dying needlessly, in filthy conditions that would shame a Third World country. It emerged on Thursday that inspectors making unannounced checks in October on Basildon and Thurrock University Hospitals NHS Foundation Trust discovered a collection of horrors: blood spattered on floors and curtains, mattresses soaked with foul-smelling stains, contaminated equipment, a high rate of pressure sores among the elderly, long waiting times in the accident and emergency department and, worst of all, poor nursing care, with old people deprived of food, attention and dignity. As a result, about 70 people in the care of the Basildon and Thurrock trust may have died needlessly: its mortality rate is a third higher than the national average. Ministers and media expressed shock and horror, but within hours there was news of another scandal of just the same sort. On Friday the regulator Monitor, which supervises NHS foundation trust hospitals, announced it had sacked the chairman of the Colchester Hospital University NHS Foundation Trust: Colchester also has higher than average mortality rates. Monitor charges the trust with poor leadership, long waiting times, poor infection screening, poor children’s services and worsening patient satisfaction. It is not often that someone gets sacked these days — something must be really bad. That makes three hospital horror stories this year, counting the reports in March about conditions at the Mid Staffordshire NHS Foundation Trust; 400 people died there needlessly. Monitor has concerns about a further eight trusts. What on earth is going on? It is bad enough that we have some — perhaps many — dreadful hospitals, even though the NHS budget has tripled in the past decade. What is even worse is that it seems difficult to have any confidence in the many people and organisations responsible for overseeing hospitals and anticipating these problems — not just bad hospitals but bad supervision. Why has it taken so long for these bad practices and poor outcomes to be noticed? The mortality figures have been available for more than 10 years. In the case of Basildon and Thurrock, the Care Quality Commission (CQC), the new independent regulator for all health and social care in England, was the body that inspected the trust and published the dreadful findings. Yet last month it posted on its website a glowing report on the trust, giving it 13 out of 14 for cleanliness and 5 out of 5 for keeping the public healthy. This report, astonishingly, is still there. The CQC knew this information was wrong; it must have realised the report would be misleading to the public who went to the site to check hospitals’ performance. Yet it has left the report on its site. One can only wonder about the information on other hospitals. Why should one trust any of it? Baroness Young, the chairwoman of the CQC, found herself in an impossible position last week, confronted with this inconsistency. Wriggle as she would under the probing of the Today programme, she could do no better than to say her organisation is only eight months old and the report on the website was done months ago under the previous regime — the Healthcare Commission — and things are going to be much better now. She failed to deal with the problem of public trust. She also failed to inspire confidence in her strange attack on the methodology of hospital mortality figures provided by Dr Foster Intelligence, an organisation the public might actually be able to trust. It is a partnership between the NHS and the Dr Foster unit at Imperial College; it provides monthly and carefully adjusted mortality figures across the NHS, which are known for their reliability and which have directly prompted all the recent investigations into problem hospitals. Dr Foster now makes a point of writing to all NHS hospital chief executives to warn them when their mortality rates begin to rise. I wonder what Baroness Young thinks is wrong with the figures or their methodology. The rest of the CQC seems to think they are all right and a useful tool for looking at hospital performance. In fact, everyone seems to accept the Dr Foster figures apart from a few ministers. On Saturday morning, for instance, Andy Burnham, the health secretary, called for an investigation to uncover high death rates across the NHS. But that information exists already, in neat monthly packages from Dr Foster Intelligence; there can be no point in calling for it, other than wearisome politics. Altogether this government’s NHS policies bring to mind an interfering child with attention deficit hyperactivity disorder. Since 1997 we have had six secretaries of state for health. That means an average of two years in post. It is impossible for anyone to understand the essentials of our byzantine health service in such short fits of attention. As for the regulators, including the one Baroness Young seems to think was not up to snuff, we have had at least three upheavals of regulations under Labour — the Commission for Health Improvement, then the Healthcare Commission and now the CQC. Such constant change must be at odds with good management. It is hardly surprising that the public has become so suspicious; there may not be many data about the death of trust in this country, but the anecdotal evidence is overwhelming. Who monitors the monitors? Not only hospital regulation is at issue. All around us this question keeps emerging. To the weary citizen, the Chilcot inquiry into the Iraq war looks just another attempt to avoid any awkward truths. No one is to be on trial; no one is to be blamed. No one has to appear, either, and Macavity Brown, to his shame, won’t be anywhere to be seen. Who is there to insist on what’s right? The Ofsted report last week was deeply depressing for its cautiously expressed findings — failing schools, illiterate children and poor teaching. What’s worse is that Ofsted and its predecessors have been inspecting and reporting fairly cheerfully for decades, while standards have fallen lower and lower. The Walker inquiry into banking is yet another affront to an angry public. Who is there to insist on public probity? That is the question, sadly. Who will guard the guards themselves?

The Sunday Times | Sunday, November 29, 2009

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