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December 12, 2009

Dr Phil’s Private Eye Column, Issue 1251, December 11, 2009
Filed under: Private Eye — Dr. Phil @ 6:20 pm

The Confusing Hospital Guide

What’s behind the spat between the government’s healthcare regulators and data analysts Dr Foster? In October, the Care Quality Commission (CQC) rated Basildon and Thurrock NHS Foundation Trust as ‘good’, before highlighting a catalogue of safety failures at the end of last month.  It alerted Monitor, the Foundation Trust regulator, who surprised everyone by sacking the chief executive…. of Colchester Hospital.  Then up pops Dr Foster claiming that, from its safety assessments, there are fifty hospitals worse than Colchester, including eleven very poor performers that neither the CQC nor Monitor have highlighted. Meanwhile, the Royal Cornwall NHS Trust, which has been graded poor by the CQC for four years in a row, received a very impressive safety rating from Dr Foster.  And although both the CQC and Dr Foster agreed that Basildon and Thurrock was in dire need of improvement, Monitor was very impressed with the Trust’s management plans.


Hospitals are complex organisations and the political imperative to reduce everyone to a single band, star rating or adjective has always been ridiculous. How do you rate a hospital with excellent maternity services, an average intensive care unit and a dysfunctional accident department? Some hospitals have good clinical services and poor financial management, and vice versa. To stamp them as ‘good’, ‘average’ or ‘poor’ is meaningless. Dr Foster has been churning out the Good Hospital Guide since 2001, but has upped its game in recent years by concentrating on patient safety. This year, it got into bed with the National Patient Safety Agency (NPSA) and developed a forthright scoring system that focuses on how likely a hospital is to harm you.  The government and CQC were unprepared for this embarrassment, not least because Dr Foster has been the recipient of sweetheart deals from the Department of Health (Eyes passim). However, it lost the NHS Choices contract in 2008 and now seems intent on proving its independence.


The CQC is currently hamstrung with an old inspection regime, and its legal powers to register (and deregister) all providers of health and social care don’t come into play until April 1 2010. However, the defensiveness with which is faced down media allegations of incompetence was pitiful, particularly the attempt to pass the buck onto its predecessor, the Healthcare Commission, which itself was limited in its powers by government.  The CQC will probably survive a Tory bonfire of the qangos, and the NPSA has improved its chances by teaming up with Dr Foster to embarrass Labour.


The highlight of the Dr Foster Guide is that it praises best practice, something the CQC would do well to learn. A year ago, the Eye highlighted how staff at Wrightington, Wigan and Leigh NHS Trust managed to turn around a very high mortality rate by cutting out extraneous bureaucratic targets and focusing on patient safety. This year, Mid Staffordshire is managing the same dramatic improvement and Trafford Healthcare NHS Trust won ‘Medium Trust of the Year’ by doing a succession of obvious things well: Bringing back matrons to audit, inspire and observe individual wards, fostering healthy competition between wards, rigorous hand hygiene, ward-employed cleaners, putting clinicians in charge of clinical services, having an early warning system to detect patients who are deteriorating rapidly and a critical care outreach team to sort them out quickly. And they also share information and best practice with neighbouring trusts.


Anyone can massage a paper assessment, but it’s much harder to hide blood under the mattress.  However, it’s often patients and relatives who spot it first, and the one factor missing form health regulation is the use of their experience to spot unsafe care quickly. In every health scandal the Eye has exposed, the red flag was raised by those on the receiving end long before the NHS saw fit to act. We have the technology to collect and analyse feedback from the frontline but not quite the willpower to use it. Patients and relatives are fobbed off, whistleblowers are still being shot on sight. What the NHS needs above all is a culture that encourages speaking up and a system to enable it, so that anyone at the sharp end can raise a concern and know that it will be acted on. The NHS is the only health system in the world attempting comparative scrutiny in such detail, and NHS Choices has made some progress in publishing patient feedback. But there’s a way to go before people feel safe to speak up without harming their care or career.