Better care…


There’s nothing worse than saying, ‘I told you so’.

It’s the last words anyone wants to hear. People can be stubborn about what they think and when it turns out to be wrong… they don’t want a reminder.

It’s better to be encouraging; ‘A lot of people thought like that and I understand why, but now it’s time to move on’.

It’s better to realise everyone gets things wrong, how ever smart, experienced or worldly wise… all of us drop the ball, make a foul-up. Warn as much as you like but people will do their own thing. All we can say is, ‘that’s not great, let’s learn and move on’.

It’s better, when people have a disaster, to be ready with a bit of friendly help and advice. If you have to say anything, you might try… ‘Ah, so you found that out!’

The NHS has found out. Found out, political fixes, for management problems, never work.

Found out what Edwards Deming, Porter, Handy, Peters, Reich, Drucker, Becker, Senge, Hammel, Tofler and all of the great management gurus and academics in management have been saying for years…

Inspection is no way to improve quality.

In a nut shell;

Turn-up, inspect and it’s good… you’ve wasted your time.

Turn-up, inspect and it’s bad… it’s too late.

Inspection has a hugely deleterious effect on organisation-morale, rehearsing for inspections costs a fortune in time and human resource. It is distracting and adds nothing but aggravation and grief.

Now, there’s serious research that, if I were another sort of person, I would be saying, ‘I told you so…’

Researchers at The University of York have lifted the bonnet of hospital inspection and in a succinct up-sum, announced;

‘… costly external NHS hospital inspections are not associated with improvements in quality of care.’

That’s it. There’s a lot more but fundamentally… that’s it.

They have calculated that one CQC inspection depending on size, costs a hospital between £169,000 and £420,000 and the preparatory activities carried out.

Strike an average cost; £294,500. There are 157 Trusts. I make that £46,236,500 of health-cash… down the khazi.

Here’s an extract from the research;

‘… [they]… looked at… data over four years on falls with harm and pressure ulcers… how they changed in relation to two regimes of inspection

One that relied on a significant input from NHS staff and lengthy visits and a second… less resource intensive.

Researchers compared both inspection regimes with trusts that were not inspected, at all, during this period.

Neither inspection system was associated with improvements in rates of falls, nor cases of pressure ulcers…

In fact… the rate of improvement was worse compared to those trusts that did not get inspected…’

Over twenty years ago the CQC was invented following the Bristol baby deaths debacle. The politicians didn’t know what to do, so they borrowed ‘inspection’ from the clip-board and flat-cap twilight industries.

As the report reminds us;

‘… several methods of inspection have been implemented and then replaced over a 20-year period… each with an increasingly complex and burdensome process…’

I’ve seen how inspection causes havoc, distracts management, demoralises staff and crushes them, when they know they can’t deliver the impossible expectations of inspectors that are time and again, reported to me, as badly trained and rude.

The CQC have busted their budget, upped their fees, recruited a load of unsuitable staff that they couldn’t get rid of. Been painfully slow in writing, often, inaccurate reports, tried to stifle challenge and have been hopeless at handing complaints.

They have trashed the careers of good people by obliging them to deliver the very targets we have dumped as impossible and resorted to classifying Trusts as ‘good’ but in the same breath denounce them as ‘unsafe’, because they don’t have enough staff. Oblivious of the global shortage of care staff.

It is time to put this chimera out of our misery.

There is data a plenty to forecast problems in the making and a telephone in every pocket.

Read the data, make a call and say; ‘It looks like you’re heading for a problem, what can we do to help?’

If we are seriously interested in safe care and better care, dump the antiquated CQC and use the money to focus, relentlessly on recruiting and training front-line staff.

There is no better way to better care.

Contact Roy – please use this e-address – roy.lilley
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Reproduced at by kind permission of Roy Lilley.