Julia Manning: After Morecambe, the sackings and reforms needed at the Care Quality Commission
A culture of fear, paternalism and concealment still stalk the corridors and wards of the NHS – and if we didn’t know it after mid-Staffs, we know it now – and in the NHS regulator the Care Quality Commission (CQC) as well. I will come back to the CQC, but the tragedies that have been covered up need to take first place. Families have lost babies and mothers at a hospital where mis-management was concealed and denied. Only those who have lost children or young parents can know the incomparable grief experienced by those families. Yet this grief has been compounded by obfuscation, rebuffs and opacity. It is only due to the campaigning by these families (again as we saw in Mid-Staffs) that is bringing the truth to light.
There are no less than 30 civil negligence claims against Morecombe Bay NHS Trust in progress. The unacceptable reality is that in far too many cases, patients have to resort to legal action to find out the truth. This is not only a deplorable burden for those who have been injured, but results in a colossal waste of tax-payers money by the NHS. Accountability is nowhere to be seen. Our hearts and thanks must go out to families like James and Hoa Titcombe who lost their new-born son Joshua, but who have campaigned for justice for all the families at Furness General Hospital, part of the Morecombe Bay Trust.
CQC, the regulator, has historically been naive and incompetent in ensuring that NHS providers are safe. However there has been a complete changeover in senior leadership over the past year in recognition of the regulator not being fit-for-purpose, and the two Davids at the top are sincere and passionate about radically rejuvenating the organisation. Top names such as former Number 10 adviser Paul Bate, Sir Mike Richards and a raft of distinguished new non-executive directors have been appointed to the CQC. So this massive error of judgement on Tuesday in redacting names from a report that the CEO David Behan personally and rightly initiated is a huge set-back in building public confidence.
As interviews have been aired over the past 48 hours, the public have learned astonishing facts that those of us in the health world already knew something of:
- CQC inspection sent teams in to NHS organisations with no relevant experience in the sector they were inspecting – even to the point of using former firemen to inspect clinical care.
- CQC has had no expectation of seeing NHS Trust reports of ‘Serious untoward incidences’ which are reviewed in secret by the Trust Board and which detail their failures of care (still the case).
- CQC has declared that it is now listening to the public – but it only follows 177 people on twitter.
Added to the CQC's admission of destroying an internal report that reflected badly on the organisation (with no apparent effort to find the report or hold those responsible to account), the public can only conclude that the CQC are still more concerned about their reputation (or historically Ministerial pressure to look good) than patient safety.
The culture of the NHS, and now it is clear, that of the regulator too, needs to change radically. There are some easy solutions that should start today:
- NHS Trust’s case reviews should be open, include patients and all affected parties, not private board meetings. Only then will there be a chance for candour, learning and timely apologies. Most people just want to know the truth and can forgive errors if they know they have been listened to and the errors dealt with.
- Those found to have deliberately hidden evidence or covered up should be subject to police investigation. Endless internal investigations and public inquiries delay justice and drive the growing spend on NHS litigation.
- CQC are putting new systems in place – but this needs to be more transparent with a ‘then and now’ for the public to see, and a fail-safe, on-line, open-view system for responding to public concerns should be on their website.
- CQC should publically sack their lawyers who advised them to redact names from Tuesday’s report.
- The two CQC managers who are still in post should be sacked, and the actions of the four senior staff who took the decision to destroy last year’s internal report – former CEO Cynthia Bower, current Media Manager Anna Dickinson, former Deputy CEO Jill Finney and current Head of Risk and Quality (the irony) Louise Dineley - reviewed by the police for possible obstruction of justice. Babies died and their parents are still in the dark as to many of the details. Jeremy Hunt should personally ensure that this happens.
- All NHS providers, Hospital, GPs etc need to be made legally responsible for safety. Accountability will mean nothing until this happens.
There is a paradox alive and extraordinary in English culture today: we are sentimentally protective of our local hospital, yet we know there is incontrovertible evidence that some staff in those hospitals have covered up not only patient’s mistreatment and failure in care, but in death. Too many staff still rebuff patients' questions, and treat them in the most objectionably paternalistic fashion. Humility and confidence are not mutually exclusive. Our trust has been blind but now we are seeing the truth. NHS staff and their regulators cannot expect to go on being the object of our undying attachment or respect without now becoming transparent, honest and accessible.