Skill – News and Comment from Roy Lilley

Last year, in their annual report, the CQC told us we were 'at a tipping point'.

This year, in their annual report, they tell us we are at a 'tipping point'.

I wonder what they'll say next year?  Whatever it is I can't see the point.

Here's how they catalogue the state of play...

  • Older people with unmet care needs, 1.2m.
  • Adult social care staffing, 90k vacancies.
  • A&E, 2.5m patients busted the four hour target.
  • Delays in hospital, 1.3m days, down to the NHS.
  • Adult social-care delays 780k days.
  • Ambulance turn-around times, 680k hours lost.
  • Acute bed occupancy, on average, 91.4%, well over the safety limit.
  • Nursing-home beds down by 4,000.

Taking all the ratings together; the missed targets, the number of Trusts and other organisations that fall within the CQC's bailiwick, in some sort of bother, means there's no reason for patients to rest easy on the pillow, or operating table.  

Sadly, the majority of patients will have little choice.  They are gonna-get, what they're gonna-get, where they're gonna-get-it, inspection or not.

The CQC report describes a service in decline; heading for a poor service for poor people.  The service they, regulate.  Powerless to influence.

At least, I think so.  I can't be sure.  Most of the inspections were undertaken so long ago... the situation might have got better... or it might have got worse.  

That's the trouble with inspection; tells you nothing useful.

Turn up, inspect and it's ok, you've wasted your time.  Turn up and it's bad... it's too late.

Another year of inspection, another £250m down the Swanee and we're none the wiser.

The report isn't worth reading, it tells you nothing that you don't know; the NHS is very busy with too many 'customers',  too few staff and no money.  Performance on a knife edge.  The CQC responsible for nothing.

There's a cunning attempt to implicate the public in the predicament the NHS finds itself in.  The report says (in terms), we are allowing our lifestyles to impede the progress of  quality in the NHS by using too much of it, too often.  

And, I get the impression the CQC are irritated with all the older-people making their reports look untidy.

There is an oblique reference to the lazy, 'sustainability' question.  They should be saying what the rest of us are saying; get back to EU average funding and the service would probably be alright.

The CQC are taking the credit for some organisations that have improved between initial inspection and a follow up.  I have news for them, it would have happened anyway.

We can dismiss this miserable report but The Tinkerman dare not.  It gives him a huge problem.  

On his behalf, the DH press office has said the NHS has had more of everything, implying the report is wrong and it's all lovely.

You know and I know it isn't and the CQC knows it isn't.  Secretly, The Tinkerman knows it isn't and the more the CQC fails to improve anything, the greater his problem.

If The Tinkerman could end this farce and put an end to fruitless inspection, I'm sure he would.  To do so he needs a new narrative.

He needs to say; 

"The CQC was invented at a time when all we had was inspection and boxes to tick.  Since then, the science of quality improvement has moved on.  

We can now use data, predictive technologies, case-note reviews and forecasting to spot problems in the making and help organisations, before simple issues become serious problems.

In response to the change in management technologies and understanding, the need to have a real-time picture of what is happening and to reflect the need for economies across the public sector, I am moving responsibility for improving the quality and safety of our healthcare to NHS Improvement and into a more digital future."

Knowing when to implement a policy takes skill and judgement.  Knowing when to end a policy takes judgement and skill. 

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