Do you believe in the Care Quality Commission?
Do you believe in the Care Quality Commission? Health Secretary Jeremy Hunt clearly does, pronouncing that a “good” or “outstanding” rating is now the “single definition of success” in the NHS. This implies that something as complex and fast moving as health care can have a single definition of success, and the over-stretched CQC – which often only produces its reports many months after it has inspected a hospital – is up to the task of measuring and monitoring it. The previous badge of excellence for NHS hospitals in England was the prestigious ‘Foundation Trust’ status, but this lost credibility after Mid Staffordshire hospital became an FT despite appalling failings in the care it provided, and it has lost further credibility after the CQC rated 33 FTs as “inadequate” or “requires improvement”. FT’s are rewarded for balancing the books, whereas the CQC rewards the quality and safety of the services provided. So a highly rated CQC trust could be a basket case financially, and a financially prudent trust could be hiding appalling care.
The CQC inspects hospitals, GP practices, ambulance services, care homes, clinics, dentists, community services, mental health services and home services in both the NHS and private sector. It’s a massive and very expensive undertaking. – of its most recent inspection ratings, 20 services were judged outstanding, 646 good, 334 require improvement and 74 were inadequate. Hunt is doubtless keen for patients to shop around and take their custom to the outstanding trusts but choice is hard in healthcare, particularly when care is needed urgently. A further complication for patients is that a single large hospital may contain a mixture of outstanding, good, inadequate and unsafe services. For example, on 17 August, Homerton University Hospital in Hackney recently received an overall rating of ‘Good’ from the CQC. It’s urgent care centre was deemed outstanding, and all of its other services were judged as good apart from Maternity and Gynaecology, which ‘Requires Improvement.’
‘The maternity unit reported a high number of serious incidents including two maternal deaths in 2013, two in 2014 and a further one in January 2015. The service was not consistently learning from all these adverse incidents and implementing all the necessary improvements. Woman and their babies were not always being adequately monitored. The environment and equipment were not appropriately cleaned. Equipment was not consistently maintained or checked…. We found the majority of issues identified at our first unannounced inspection, such as the environment, documentation and patient safety, which the trust stated they had taken action to address, had not been resolved when we returned one week later for an announced inspection.’
Read further and the CQC report gets even more unsettling. ‘Not all incidents in maternity service were reported. There were unacceptable levels of serious incidents and never events. Reported incidents were investigated but the response was slow resulting in continued potential risks to mothers and their babies. Staff were not proactive in maintaining a safe environment and both the environment and equipment were not appropriately cleaned. Resuscitation and emergency equipment had not been consistently checked to ensure it was ready for use. Drugs were not administered or stored safely in the maternity service. Midwifery staffing levels were less than the recommendations of Birthrate Plus. Some shifts on the labour suite were staffed predominately with bank and agency staff.’
None of this is news to readers of the Hackney Gazette, where an anonymous whistleblowing group called ‘the unhappy midwives’ have been raising concerns about the quality of maternity care for some time. A separate petition was set up to investigate neonatal deaths. The Eye received an allegation of a delivery where a baby’s head became separated from its torso. In response the trust stated that ‘Legally we cannot discuss details of individual cases. We can confirm that on that day there was a delivery of a non-viable foetus and this was reported to the Coroner’s Office who felt that this did not require further investigation.’ The CQC appear not to have been told about this.
Homerton provides maternity services for 252,000 people in Hackney, and its maternity unit delivered over 5,500 babies in 2014. It’s caseload is huge and extremely complex, and yet for the maternal death rate to be so high and the service to be judged unsafe on so many measures suggests it is not a unit you would choose to have a baby in. And yet the vast majority of people who use its services have no choice, whatever Jeremy Hunt or the CQC says. So how will Homerton improve? Or Addenbrooke’s?
MD’s book, Staying Alive – How to Get the Best from the NHS – is available here