Blundering, bloated and biased – the NHS watchdog not fit for purpose

Published by The Daily Mail (20th January, 2015)

Britain’s health service is much too important to be treated as a political football. Indeed, last year I wrote an article expressing such concerns and suggesting that MPs should focus on finding ways to save this sickly institution, which was struggling to survive amid fast-rising demand and costs.

The fact is that those problems in the NHS have since got worse and proper reform is long overdue.

My article also mentioned how depressing it was that ‘privatisation’ had become the dirtiest word in the health lexicon — and, as always when this issue is raised, it sparked a hostile response from a small group of sanctimonious medics and their supporters.

These self-appointed saviours of the NHS give the impression of hating the idea that patients and taxpayers might want a say in what they consider to be ‘their’ service.

Of course, such a debate is welcome, but I did not expect a key figure at the Care Quality Commission (CQC), England’s official health watchdog, to start abusing me on Twitter. Nor, indeed, for a second official to congratulate one of my critics for his ‘fabulously excoriating piece’.

When I contacted the state-funded organisation to query whether it was right that officials should be engaged in such overtly political actions, I was told this was fine since these were their personal views.

Given this, I was not surprised to learn from the Mail’s investigations over the past few days that this same body is involved in a potentially scandalous stitch-up over Hinchingbrooke Hospital, the country’s first privately run NHS hospital.

Yet the sad truth is that this bloated, blundering behemoth of a watchdog is simply not fit for its purpose — as many in politics, social care and medicine have pointed out during its miserable six-year existence.

The CQC has an appalling record of failure that has left patients in pain, elderly people mistreated and individuals with learning difficulties abused.

Created to cut costs by merging three other regulatory bodies, the CQC has been overloaded with responsibility by successive governments, with the result that its inspectors are meant to protect patients in a huge range of areas, from care homes to hospital wards, from dentist’s chairs to prison clinics.

And when confronted with medical failure — even involving the fatalities of babies or mistreatment of elderly people — all too often its inclination has been to cover up its own incompetence and hound whistleblowers, rather than deal openly and honestly with patients, families and staff.

The core problems seem twofold: it is simply too big and unwieldy a body, while too many officials remain locked in an establishment mindset rather than seeing themselves as crusading outsiders. Indeed, it is hard to think of another important public body that has been handed extra duties despite such a lethal track record of failure.

Little wonder it has been condemned by a cross-section of society — from MPs and patient groups through to the BMA.

Yet the CQC’s scathing report into Hinchingbrooke was a key reason, along with fiscal pressures, for the private company that was running the hospital to withdraw from its pioneering contract.

This caused dismay for many patients and staff, who fear it will close or lose departments — but, naturally, delight to politicians on the Left.

The Mail has made alarming revelations that the watchdog’s lead inspector had opposed privatisation; that a second inspector had been linked to an anti-privatisation group; and that a major recent survey which had showed high levels of patient satisfaction was seemingly ignored.

Clearly, there are questions over the watchdog’s political neutrality on an issue that is now at the heart of the nation’s political debate about the future of the NHS.

But even more important are the questions of whether this organisation is up to the job of protecting the public when they are at their most vulnerable. A glimpse at its track record shows why it should be broken up into separate constituent parts.

Originally, the CQC was created in 2009 by Gordon Brown’s government following the money-saving merger of three disparate regulators: for the NHS, for social care and for mental health services.

Yet a damning parliamentary inquiry later found there was not ‘a sufficiently clear and realistic definition of its priorities and objectives’.

In its first week, it was forced to defend the appointment of Cynthia Bower as chief executive — an official closely linked to management failings that led to the deaths of hundreds of vulnerable patients in two Mid-Staffordshire hospitals.

The public official entrusted with the responsibility of protecting patients casually confessed the problems had not been on her radar, telling an inquiry: ‘Mistakes are made, people do die unnecessarily.’

The chairwoman quit by the end of the year after her watchdog’s credibility was thrown into doubt amid concerns over patient deaths in a hospital in Basildon, Essex — which was branded the worst in England even though, weeks earlier, the CQC rated it ‘good’ for care.

Obsessed with bureaucracy, the regulator initially focused so hard on registering thousands of dentists that it scaled back its core duty of inspecting hospital and care homes.

Inevitably, the result of this ‘light-touch’ regime was a series of horrific cases of abuse and mistreatment. It duly acquired a record of presiding over a series of care home scandals.

Among the worst was its failure to respond to a whistleblower who had highlighted people with learning difficulties being bullied by staff at Winterbourne View in Bristol, a residential care home.

The whistleblower then took his findings to the BBC, which, in a highly distressing edition of Panorama, exposed vulnerable patients being pinned down, taunted and teased.

Dr Heather Wood, who led the Healthcare Commission investigation that revealed appalling standards of patient care at the Mid Staffordshire Trust, but who saw her investigations team broken up by the CQC, damningly told a public inquiry that the watchdog was ‘firmly part of the NHS establishment’ and seemed ‘anxious not to rock the boat’.

Her opinion seemed well-founded. One official confessed astonishingly that it took ‘a groundswell of opinion’ to persuade them ‘our best evidence comes from stepping over the threshold at locations and speaking to service users and staff’.

Ms Bower finally quit in 2012 — with a £1.48 million pension pot — after allegations about the cover-up of flawed inspections at a maternity unit where 16 babies had died.

A much-improved new team was installed in an attempt to get a grip on the body — although its chairman, former Tory MP David Prior, admitted he is ‘not a natural regulator’.

Unfortunately, the blunders have continued. Last year, it was found to have hired dozens of inspectors who had failed its recruitment process; last month, it wrongly categorised 60 GP surgeries as high-risk after muddling up its methodology.

‘Our reputation, which has been built up over many years, has been tarnished by the incompetence that they purport to eradicate,’ a furious Suffolk GP told the BBC.

Jeremy Hunt, the first Health Secretary squarely on the side of patients for many years, has told people privately he thought about killing off the watchdog, but concluded that the NHS did not need more upheaval.

Instead, Hunt loaded more duties on a body already wilting under its responsibilities, introducing a new inspection regime for GPs nine months ago.

This means the CQC’s 2,642 staff are responsible for monitoring 8,592 GP practices, 17,350 residential care homes, 8,110 home care services, 10,102 dental clinics, 276 acute hospitals, 162 NHS trusts, 202 hospices, 58 mental health trusts and 146 prison healthcare units.

The body also received 238,621 calls last year from members of the public and had to sift through 9,473 whistleblowing contacts.

And now the CQC has been branded a ‘disgrace’ after elderly patients in one care home had to endure months of appalling treatment before officials finally intervened.

Looking back, I believe that the creation of the CQC was a mistake — and one that looks worse with each passing year. It is time to break up the behemoth.

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