In July 2013 I wrote a blog on this subject which I published on the Morecambe Bay Inquiry Action website. I copy some key extracts below.
“In the weeks since the Keogh review was published, there has been a furor as each political party has sought to point out mistakes made by the other. The truth is that both governments have failed to get the NHS right and it shouldn’t be considered being party political to talk about it. In fact, talking about it is exactly what we should be doing.
With the Francis report, the Grant Thornton CQC scandal and the failures identified across 14 other NHS trusts by the Keogh review, we do at least now appear to have come to a watershed moment. Hunt has now articulated what many patient safety campaigners have been saying for years; that regulation of the NHS has been dysfunctional, that too often the culture has been to cover up and hide problems and that standards of care in some parts of the NHS have fallen far below any acceptable standard. Whilst some people will argue about mortality statistics, the undisputable fact is that thousands of people have suffered appalling standards of care and there have been far too many preventable deaths across the NHS as a result.”
The blog talked about some of the reasons that I felt had contributed to this situation. The way Foundation Trusts had been implemented, an over focus on targets without a strong enough focus on quality and safety, changes in the complaints system and weaknesses in the regulatory system. I also talked about another influence; the real concern that towards the period of time leading up the last General Election, a culture of ‘no bad news’ seemed to develop.
The blog quoted a number people to illustrate the point.
Roger Davidson – “…there were conversations between the CQC and Ministers to the effect that the CQC would not cause any trouble…”
Brian Jarman – “the problem was ministerial pressure, even from Number 10.”
Barbara Young, Labour peer and chair of the CQC, under oath to the Francis inquiry said “the government hated the idea that the regulator would criticise it…” and spoke of pressure from politics.
I wrote that “…the fact that so many have expressed the same feeling shows that this sense of pressure must have been coming from somewhere. No one working within an organisation responsible for regulation of healthcare should ever feel or suspect there was political pressure on the organisation to underplay problems and this must never be allowed to be the case again.”
In the 18 months since I wrote my blog, I’ve been privileged enough to work in health and social care regulation. I’ve seen the significant changes that have been made. There has also been huge progress more widely. Sign up to safety, patient safety collaboratives, the introduction of a legal duty of candour and Sir Robert Francis is conducting the speak out safely review that will hopefully lead to further important recommendations to improve the culture of the NHS.
With more openness and transparency and with a more robust regulatory framework, which for the first time assesses providers against a clear expectation of what ‘good’ looks like, it is inevitable that care quality problems will be highlighted with greater consistency than has happened in the past.
My previous blog included an optimistic note.
“On a personal level, since losing my son due to failures in care in 2008, I have never felt so optimistic about the direction of change, but I also know much more needs to be done”
18 month later, I continue to be optimistic. There has been huge progress but the journey of culture change and improved safety in healthcare needs to continue on the same trajectory for many years to come.
My 2013 blog finished with the following paragraph.
“The NHS will continue to be a hugely political subject but recent history has shown that the most effective way to gain public confidence and trust is not defensive denial, but by openly acknowledging failures, setting out a clear agenda for change and then taking swift and decisive action.”
As we approach the May 2015 General Election, this is a principle that we would all do well to remember. The right way to demonstrate control of the NHS is surely to have confidence that where problems exist, they are identified and acted on. Having made unprecedented progress to ensure that this is now the case, nothing would be more perverse than manoeuvring which seeks to politicise care quality issues when they are highlighted as being an indication of a lack of control.
The truth of course, is that the exact opposite is the case.
Patients and relatives affected by events like Mid Staffs, Morecambe Bay and elsewhere know what the consequences can be if this message gets lost. This is something that all politicians need to commit to ensuring doesn’t happen again.