NHS on brink of crisis because it became too powerful to criticise

Mark Russell · Dec 21, 2013

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The Daily Telegraph reports:

Head of health and social care regulator David Prior says NHS has been damaged because criticism was not tolerated. Isn't that a surprise?

Daily Telegraph said:

THE NHS should not be treated as a “national religion” while millions of patients receive a “wholly unsatisfactory” service from GPs and hospitals, the official regulator has warned.

David Prior, the chairman of the Care Quality Commission, said the health service had been allowed to reach the brink of crisis because it was “too powerful” to be criticised.
He said parts of the NHS were “out of control” because honest debate about the weaknesses of the health service was not tolerated
.
In an interview with The Daily Telegraph, Mr Prior also criticised the target culture at the NHS. He said it was “crazy” that the Health Secretary Jeremy Hunt was directly telephoning hospital chief executives who had missed A&E targets.

Failings that put patients at risk had been allowed to continue for years, he said.

It became too powerful to criticise,” he said. “When things were going wrong people didn’t say anything. If you criticised the NHS – the attitude was how dare you?
“No organisation should be put on such a high pedestal that it is beyond criticism. Now it is getting more honest about our failings — which I think makes it more likely that we will address them.” Mr Prior said priority must be given to reform of an “out of control” system of emergency care, overloaded by patients who cannot get decent care outside hospital.

It was “wholly unsatisfactory” that so many patients struggled to get an appointment with their GP. Mr Prior suggested that some hospitals should take over these services.
“Their opening times have to be geared around the patients,” he said. “It’s no surprise that Sainsbury and Tesco do most of their business outside office hours because that’s when people can get to shop. Working people need to be able to see their GP in the evening or at the weekend.”

Mr Prior suggested that the “target culture” imposed by Labour a decade ago fundamentally damaged the culture of the NHS, creating a “chillingly defensive” operation in which the truth was often sacrificed.

“The whole culture of the NHS became so focused on targets that it obscured what real quality was about,” he said. “The voice of the patient wasn’t in those targets.”
In April the CQC will publish “Ofsted-style” ratings for all hospitals, with a similar system to be introduced for GP practices by 2016. Mr Prior said he expects about 30 trusts to receive the lowest rating.

He said many hospitals needed radical reform.

Mr Prior said he would like to see “chains of hospitals” across the country where successful organisations take over failing ones, stripping out administrative and management costs, and rationalising services.

He said: “I think the isolated district general hospital will be increasingly seen as a relic of the past.”

In some cases, hospitals should take over community and GP services. If one organisation offered all the services, it would have a stronger financial incentive to prevent patients becoming acutely ill. He said: “I think this could be huge.”
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Mark Russell · Dec 21, 2013

The interview..

A howling wind grows louder as the man in charge of inspecting the NHS considers the question of how the country’s hospitals are likely to cope this winter.

Last year some of the most senior doctors likened Accident & Emergency (A&E) units to “warzones”.
Many fear that in the coming months, the NHS could face its greatest test yet.

From his office on the 15th floor of London tower block, David Prior, the head of the Care Quality Commission (CQC) can see for miles - a fitting location for a man whose job it is to oversee 250 hospitals, 8,000 GP practices and 23,000 care homes.

But it is exposed to the elements - and the large plate glass windows seem to rattle yet more loudly as he considers the growing winter presssures on hospitals.

“There are a lot of A&E departments now that are already on black alert a lot of the time; in the end a huge amount of this will depend on the weather. All we know is that it is going to be very tight,” he says.
Chance plays a major part in seasonal pressures on hospitals, but while a robust NHS can cope with high levels of flu, bleak weather or surges in the winter vomiting bug, Mr Prior is deeply concerned about the shape the system is in.
The former Tory MP and deputy party chairman fears that A&E departments are “out of control” - with the system on the brink of collapse because too many patients are arriving at hospitals as an emergency because they did not receive help from GPs when they needed it.
He is forthright - and he fears that part of the reason that hte NHS has been brought to the brink is because until recently, debate about failings in services and risks to patients was simply not tolerated.

Mr Prior became chairman of the watchdog last January.

Within weeks, the NHS was shaken by some of the most disturbing criticism in its history, with the findings of the public inquiry into the Mid Staffs hospital scandal, where there were hundreds more deaths than expected amid appalling failures in care, in the last years of Labour.

As he got to grips with his new role, he was alarmed by the “chillingly defensive” culture he encountered in the NHS, he says - where even the most “alpha male surgeons” felt frightened to speak out about poor care, because to do so was career-ending.

Bereaved parents whose babies died amid a catalogue of failings told him how their the pleas for truth fell on deaf ears.

“I had not realised that the culture in some of our hospitals was so damaged,” he says. “That was an awakening. So many clinicians felt bruised, battered and marginalised.”
Somehow, the health service was placed on a pedestal, beyond reproach - a culture which he believes has only begun change, in the wake of the Mid-Staffs public inquiry.
“When you are compared to a national religion, that is the problem,” he says, with reference to Nigel Lawson’s description of the NHS. “It became too powerful and too iconic to criticise. When things were going wrong people didn’t say anything because somehow you couldn’t - in the same way that you couldn’t publically have a debate about immigration until recently, because somehow you would be branded a racist.”

“If you criticised the NHS - the attitude was how dare you?” he continues. “No organisation should be put on such a high pedestal that it is beyond criticism; now it is getting much more transparent and open and honest about our failings - which I think makes it much more likely that we will address them.”

The former Tory MP feels “much more positive” that the culture is beginning to change than he did when he first took up post 11 months ago, he says, but suggests old habits die hard - for politicians as well as those working in the NHS.

In opposition, the Conservatives and Lib Dems derided the “target culture” imposed by Labour, which they said damaged patient care, and pledged to put patients before central diktats. In reality, the grip holds firm, he says.

“I think targets can be hugely distortive,” says Mr Prior. “I know what happens. Every time a patient arrives [in A&E] the clock starts ticking and not a lot happens for two hours. At three hours people start to get interested - and then at three hours 55 minutes the chief executive is down in the A&E department. That doesn’t make any sense.”
Amid deepening concern about how hospitals will cope this winter, in recent weeks, the Health Secretary has taken to directly phoning the heads of NHS trusts who are missing A&E targets within hours of the latest figures being released.

“There is an obsession,” says Mr Prior, with apparent frustration. “It’s crazy to have a Secretary of State doing that - of course he’s doing it, because he’s held accountable in the end, but what it all leads to is more money being put into A&E departments to get them through winter, when that money should actually probably be being put into primary and community care to stop people falling ill.”

He believes the focus on waiting time targets under Labour drove a wedge between clinical staff - doctors and nurses - and the managers who enforced them, creating a “breakdown” in trust between the two groups.

Mr Prior hopes that a new system of “Ofsted-style” ratings being introduced for hospitals and GP practices - telling the public whether their local service is outstanding, good, requires improvement and inadequate - will battle against the target culture, and force services to behave as patients want them to.

The first ratings for hospitals will be published in April - a “big test” of the regulator, he says. “That’s the main driver taking us away from targets.”

The former barrister worked for investment banks, British Steel and other companies, before being elected as a Conservative MP for North Norwich for a term in 1997, and becoming deputy party chairman until 2001.

He also spent a decade as chairman of his local hospital trust - and since 2010 has chaired two free schools and two academies - both policies which have been fiercely championed by Michael Gove, the Education Secretary.

In many ways, health is following the lead of education, with the regulator being given total independence from Government, and Mr Prior is enthusiastic that it should be so.

If CQC’s pronouncements embarass Mr Hunt - and suggesting the Health Secretary’s approach to targets is “crazy” might indeed cause a few blushes - so be it.

“What has struck me in the last few months is that when Ofsted did a damning report about free schools - which obviously were Michael Gove’s baby - they didn’t worry about embarrassing Michael Gove,” says Mr Prior. “When Jeremy Hunt made us independent he was giving us the same power. So I think being independent both of politics and the system - and the two are very distinct - is really important to us and I think the Ofsted model in that respect is a very powerful one.”

His role is quite simple, he suggests.

“Only by revealing the truth can you restore trust in the NHS. That is where we have to be - speaking truth to power.”

That is not the organisation he walked into.

Earlier this year, in the wake of Mid-Staffs, the watchdog - which is supposed to guard the public from just such abuse - became embroiled in a scandal which threatened its very existence.
An investigation into the CQC’s handling of concerns about a succession of baby deaths in Morecambe Bay accused senior executives of presiding over a “cover-up” and ordering the deletion of documents which would have shown their failings.

Those officials had already left the watchdog, but the handling of the affair was a major test for Mr Prior, a former Tory MP and hospital chairman, and the watchdog’s recently appointed chief executive, David Behan.

Many have suggested that the previous team had become too close to Labour, and that this was what put pressure on them to hide NHS failings, and paint a positive picture.

Mr Prior makes a distinction.

“I don’t think it was in hock to Labour - I think it was in hock to ‘the system’ - the regulator became part of the system and I think that maintaining trust in the system - by not exposing all the poor things that were going on - was regarded as more important than anything else,” he says. “That’s where I think the CQC went fundamentally wrong and where we now set out to be radically different.”

The culture within the watchdog reflected that of the NHS, he says.

“I think it mirrored what we were regulating - it was very defensive, closed and it was quite a bullying culture. It was not a happy place.”

The regulator hopes that sweeping changes - including appointing chief inspectors in charge of hospitals, GP practices and care homes, the recruitment of hundreds of specialist inspectors and the publication ratings will make a radical change to the way the regulator behaves - and the confidence the public can have in it.

“Our only duty is to the public - not to our political masters so that the public has confidence in us and knows we are not part of the system,” he says.

In April ratings for all hospitals will be published.

Mr Prior hesitates to estimate how many are likely to be found to be failing but suggests he would not be surprised if 30 NHS trusts were branded inadequate.

As the regulator, his job is to take a “pure judgement” on the quality of the service - not to decide how improvements should be made, he stresses, but he says he is no fan of “mass firings” and believes there is already too much of a “merry-go-round” in the NHS among senior managers, with the average chief executive spending less than two years in post.

“This trial by humiliation is not something that we want to see in the NHS,” he says, “We want accountability - we don’t want ritual slaughter.”
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Mark Russell · Dec 21, 2013

http://www.bbc.co.uk/news/health-25475354

W J Liggins · Dec 21, 2013

In some cases, hospitals should take over community and GP services. If one organisation offered all the services, it would have a stronger financial incentive to prevent patients becoming acutely ill. He said: “I think this could be huge.”

Hollow laugh. I'm old enough to remember when this was the case with Health Authorities and the system was split to create 'increased efficiency'. What it did was to create increased numbers of managers and other jobsworths.....Le plus ce change..........

Bill

spike123horse · Dec 29, 2013

or they could just move the deck chairs around the deck of the titanic after the iceburg??? shouldn't it just start again???is this even possible??

NHS on brink of crisis because it became too powerful to criticise

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Advice needed nhs or private?

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NHS on brink of crisis because it became too powerful to criticise

Mark Russell MVP

Mark Russell MVP

Mark Russell MVP

W J Liggins Well-Known Member

spike123horse Active Member

Advice needed nhs or private?

Selling additional sets of orthoses to NHS patients

NHS charging/billing codes

Private practice vs NHS

Hyprocure Stent Operation on the NHS

NHS Pod wanted to do have a few private patients on the side.

South West footcare initiative scoops top NHS award

Share This Page

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