Failed by quality…

Primary Care Training_NHS General Practice_Failed by quality...

I’m not quite sure how to start this morning’s conversation.

I have thought about it, every-which-way.  I’ve decided, head on…

You will know I have never been a fan.  It’s not just me.  Everyone who knows anything about management, anyone with an ounce of common sense will tell you; it was never going to work… and it hasn’t.

It was a bad idea, right from the start.  Born of events when government needed to look busy.

The Bristol Baby calamity hit the headlines.  Human tragedies, professional disasters, alleged coverups… you name it.

As the grinding bureaucracy took its time, Ministers had to act.  And they did.

Based on the false premise that inspection would eradicate the possibility of another horror, the CQC, or I should say, its predecessor organisation, was born.

There is almost no evidence that inspection has improved anything.  Industry has abandoned it.  

Whilst the NHS has been inspected, more catastrophes have occurred, babies died, care homes close, regulations breached, targets failed and fine men and women seen their careers trashed.

Mostly the NHS has been too timid to tell the truth about the CQC.  To stand up to, frankly, institutional bullying.

Rehearsing for an inspection visit can cost a Trust, £250,000.  The distraction, management time, angst… all additional, hidden costs.

The common law of management logic tells you, if you know what you are going to be inspected for and when, you’d have to be a real dunderhead not to emerge with flying colours.

Yet, despite companies paid to coach Trusts and their people, how to pass, and rehearsals, drills and practice… Trusts still get low ratings.

No one ever asks why?  

The assumption is, if a Trust was better lead everything would be OK.  Sack the Board, or the Chief Executive.  Start again.  Indeed, the tenure of Trust chiefs, at one time, was less secure than a football manager.

The reasons for inspection failure?  Impossible, made-up standards, knowing full-well Trusts are prisoners of their history, geography and economy.  Opinion based critiques, poor value judgements, inadequate training, settling scores… how long have you got?

That aside, the whole of academic management, business watchers and people who know a thing or two about practical management will tell you.  They all say the same.  With one voice; inspection is no way to manage quality into any activity.  It encourages tyranny. 

In practical terms… turn up and inspect and it’s good, you’ve wasted your time; turn up and it’s bad, it’s too late.  Quality is what you do when no one is looking.  Quality is built in, not bolted on.

The public are entitled to look to politicians to keep them safe.  Both on the streets and in the NHS.  Political decisions have not served us well.  

The CQC has not made the NHS safer.  Spectacular failures, escalating legal costs, disaster headlines, wrong-site operations, never-events, prescribing errors, staff shortages the evidence is irrefutable.

Rootling about for superficial failures ignores the root causes.  

Over 20 years of inspecting for quality.  In that time we have seen technological developments, improving management understanding, better use of financing and awareness of what works… all have evolved into a different NHS.  Nothing to do with inspection.

The HSJ’s exclusive report of the collapse of morale at the CQC, poor leadership, badly implemented change would, were it a hospital, a practice, pharmacy or community service, have marked it out as a failing organisation.

Isn’t it time for a clear out at the top?  It is certainly time for the Board to realise, they are not managing change, they are managing decline and failure.

The Confed, Providers, NAPC, the Shalfords, the Mulberries, unions, the think-tanks should find the guts to say what the dogs in the streets know…

…it is time for a narrative that says; when we started to look for quality improvements all we had was a clip-board and a box to tick.  Now, we have data, algorithms and machine learning.

We are able to spot problems in the making, warn leaders and support them to sidestep disaster.  Keep us safe.When there are viable, sensible alternatives, to carry on with clapped-out inspection wins no applause from the people failed by quality.

News and Comment from Roy Lilley

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Reproduced at by kind permission of Roy Lilley.