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Out-of-hours firm had systemic failings, CQC says

BBC Health - 15th July 2010 9:33 am

A company providing out-of-hours care in an area where a pensioner died after a painkiller overdose had “systematic” failings, the NHS regulator says.

David Gray, 70, from Manea, Cambridgeshire, was killed by Dr Daniel Ubani, a German medic working his first NHS shift for Take Care Now.

The now-defunct firm was criticised for failing to act on previous cases and warnings on standards.

The Care Quality Commission said the whole NHS should learn lessons too.

The CQC criticised Take Care Now (TCN) for failing to investigate and learn from two previous cases of diamorphine overdoses prior to Mr Gray’s death.

One in six CQC staff think regulator is well managed

HSJ - 13th July 2010 11:58 am

Only 16% of the Care Quality Commission’s employees think it is well managed, leaked internal staff survey results reveal.

The survey, filled in by 1,473 staff in May - a 76% response rate - reveals employees highly rate their line managers and teams.

The vast majority said they felt able to ask members of their team for help or advice when needed and agreed their team co-operated to get work done.

But only 14% said they had confidence in decisions made by the executive team and 16% said the regulator as a whole was well managed.

Just 7% said communications between different parts of the CQC were effective.

Where’s the evidence for costly regulation?

By Tom Goodfellow - 29th June 2010 3:55 pm

Sporting matters may have recently pushed the BP Gulf oil leak off the front pages, but millions of gallons of the stuff are still being pumped into the sea with, as yet, unquantifiable consequences and no clear end in sight.

This may be the worst environmental disaster ever seen. Drilling for oil at that depth is very risky, yet to what extent did the international oil companies prepared for such an eventuality?

In June, senior executives of five of the other big companies appeared before US Congressmen on Capitol Hill to give an account of their own preparedness for a major disaster, and it was indeed a sorry spectacle by all accounts.

Each company blamed BP for making fatal errors, but insisted that they had robust contingency plans to deal with such an eventuality. In fact ExxonMobil’s plan contained 40 pages on dealing with the media but only nine pages on how to handle the leak itself. However it did contain information on how to protect walruses which, as it happens, are not found in Gulf waters.

Further probing revealed that the five companies drilling for oil in that region had virtually identical plans and that these were written by the same Texas sub-contractor. They were deemed largely to be “fantasy” documents.

This brings us to the heart of the matter which is that such risk management and regulatory policies are frequently aspirational and theoretical but are rarely grounded in practical experience.

All NHS trusts will have extensive risk management policies running to many pages, which will list detailed chains of responsibility right to the trust board level. Previously compliance has been regulated by a variety of bodies, the latest manifestation of which is the Care Quality Commission which is now the body with overarching responsibilities to regulate “all health and adult social care providers”. The aim is that “all providers must show they are meeting new essential standards of quality and safety across all of the regulated activities they provide”.

This seems a worthy aspiration. But when I try to read the CQC document, Essential standards of quality and safety (all 274 pages of it) why do I get that accustomed sinking feeling that this is yet another NHS behemoth? The work involved to demonstrate compliance, and indeed to assess it, will be vast and will generate further armies of managers and bureaucrats costing the NHS millions. For small organisations the work and costs could prove crippling. And the benefits? Largely unproven, like so many of the other costly regulatory systems which have proliferated over the last few years.

In 2002, Prof (now Lady) Onora O’Neill gave a brilliant series of BBC Reith lectures entitled, A question of trust. The third in the series, Called to Account, delivered at Addenbrookes Hospital, is worryingly prescient and should be read by all who have and interest in, or are concerned by such matters.

Tags: CQC, Regulation
Posted in Tom Goodfellow | 4 Comments »

Hospital death rates a “poor measure of quality”

BBC Health - 21st April 2010 11:21 am

Death rates are a poor measure of hospital care and should not be used to trigger public inquiries, experts say.

The BMJ analysis argued the figures were a “poor test of quality” and urged inspectors to rely on other measures instead.

It contrasts with the pressure mounting on the Care Quality Commission to pay more attention to death rates produced by Dr Foster, a private research group.

The NHS regulator said death rates was just one part of the armoury.

The two experts in disease monitoring, Professor Richard Lilford, from Birmingham University, and Peter Pronovost, from Johns Hopkins University in the US, criticised the way death rates were used to castigate Stafford Hospital over the past year.

It was widely reported that an extra 400 people may have died as a result of poor standards at the hospital - a figure which was based on average death rates. But the experts said the claims were “precarious”.

They concluded death rates were too blunt and were only being “kept alive by well-meaning decision-makers”.

Ten more trusts registered with conditions

HSJ - 26th March 2010 3:33 pm

A second wave of registration decisions by the Care Quality Commission has highlighted problems at 10 trusts.

A further 214 trusts have been registered with the CQC ahead of the 1 April deadline, but for 10 organisations this is conditional on them making urgent improvements.

The following trusts have all been registered with conditions:

1. Devon Partnership Trust

2. Kent and Medway NHS and Social Care Partnership Trust

3. Luton and Dunstable Hospital Foundation Trust

4. Mid Essex Hospital Services Trust

5. Northern Lincolnshire and Goole Hospitals Foundation Trust

6. Scarborough and North East Yorkshire Healthcare Trust

7. Surrey and Borders Partnership Foundation Trust

8. Surrey and Sussex Healthcare Trust

9. West London Mental Health Trust

10. Yorkshire Ambulance Service Trust

CQC chair Jo Williams said: “We have set out the action we expect and now it is the responsibility of trusts to ensure improvements are made. These are essential standards that every patient has the right to expect in any NHS service.”

Whatever happened to straight talking?

By Stephen Campion, chief executive of HCSA - 10th December 2009 9:08 am

In the past few weeks, the word ‘accountability’ seems to have raised its head above the parapet yet again.

Questions of NHS regulation and performance hit the headlines with the unexpected resignation of Baroness Young as chair of the Care Quality Commission. The public (and I count myself in that number) remain confused about how Basildon found itself between being both a good and bad hospital at the same time. How much confidence do we have in the quality of regulation and the ability of ministers to accept accountability?

That is not just a question for the NHS. It affects all government departments; and their response when things go horribly wrong provides a good insight into damage limitation and the marvels of political spin. Sometimes it is difficult to know where the buck starts, let alone stops!

Take this example. I was in the car on Tuesday evening listening with ever increasing incredulity to a classic performance of “how not to answer the question” on Radio 4’s PM programme. The subject? Not the NHS this time, but an interview with David Lammy, Minister in charge of our universities responding to a damning report on the Student Loan Company. If you have a moment it is worth listening to.

You might think that the answer to Eddie Mair’s simple question: “Is the person who was in charge of the Student Loan Company at the time of this fiasco still in charge of the Company?” would be a simple yes or no. Far from it. The reply was this: “The Chair has said that he is looking to strengthen and re-organise the senior management of the team and it is right that I allow them to do that with the due process that you would expect to take place.”

Eddie Mair tried again to elicit a simple answer: “But the person who was in place when it all went wrong remains in charge?” Answer: “There will be changes to strengthen and re-organise the senior management of the team but I am also making clear that it is not for me, as a minister, to determine the outcome of that. I look to the Board to do that and it’s right that they follow due process in doing that and in employment law.”

Not for the first time, I lost the will to live listening to such obfuscation. The words yes or no seem to escape those charged with running our public services. But the minister has done his colleagues a huge favour. His interview provides the perfect template for any government minister, permanent secretary or quango chief to use when things go wrong. They would do well to keep this reply on file. But I can’t help feeling that for proper accountability to work the better answer is a simple yes or no!

Tags: Basildon, CQC
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Shock resignation of Care Quality Commission chair

Healthcare Republic - 7th December 2009 1:22 pm

The chair of the Care Quality Commission (CQC), Baroness Young, is to stand down from 1 February.

The Guardian is reporting that she quit after a ‘difficult’ meeting with health secretary Andy Burnham when it emerged investigators were being sent into an Essex hospital because dozens of patients are thought to have died due to inadequate care.

A month earlier, the CQC had rated the quality of care at the hospital as good, leading to a row about the CQC’s credibility.

Barbara Young said: “Having overseen the major task of creating a single regulator for health and social care and pointed it in the right direction, I have decided that it will be for others to take it forward. I wish all success to the Commission and its staff and to Dame Jo Williams who has agreed to act as chairman until a successor is appointed. Jo will start to take up the reins in January.”

Shadow Conservative health secretary Andrew Lansley said: “I believe Barbara Young wanted to end the flawed Healthcheck assessment system and to have better enforcement powers alongside the registration system from April. Her decision to leave before April demonstrates the breakdown that has happened between Labour ministers and their flagship regulator.”

Basildon is more pressing than climate change

By Mike Broad - 27th November 2009 4:24 pm

A long time ago, I studied a bit of meteorology. My abiding memories are not about occluded fronts and cumulonimbus clouds, but a general wonder at the complexity of the discipline.

Every prevailing weather system is the product of an incredible range of influences from solar cycles and jet streams to ocean currents and the shape of land masses.

There aren’t many things more complicated than a human body, but the weather is probably one of them.

So, to suggest we now understand the weather - for all our sophistication in modelling - is frankly ridiculous. The climate is changing. Human activity probably does have something to do with it. It’s probably worth lowering our carbon emissions, even if in the fullness of time it proves to be less significant than most currently believe. As far as I’m concerned, for the non-expert, that’s about as definitive as you can be.

So, why on earth are doctors’ representatives banging on about it? Doctors from “around the world” have launched the International Health and Climate Council to pressure governments into action over climate change. And The Lancet has backed it up with some articles on the health consequences.

Of course, we should all do our bit to reduce our carbon footprint (and I like to think I do more than most). But, is President Obama’s thinking at the upcoming Copenhagen Summit on Climate Change really going to be influenced by a bunch of doctors and their trade mags offering up sound bites on issues that are far removed from their areas of expertise?

I somehow doubt it. And yet this week they’ve taken the opportunity to pump more hot air into the atmosphere about the health consequences.

It’s funny, but I didn’t hear many of them talking about the real health stories this week at Basildon and Thurrock NHS Trust and Colchester Hospital - not in public anyway.

We’ve got a real crisis on our hands and there’s no nice PR opportunity in it. Standards faltered at Basildon and Colchester, as they did at Mid Staffs, despite a supposedly tight regulatory system. The consequences were severe.

A report by Dr Foster Intelligence rated a dozen hospitals as “significantly underperforming”, despite nine of them being rated good or excellent by official regulator the Care Quality Commission.

Seven hospitals were also found to have considerably higher mortality rates for the past five years.

It raises difficult questions: how do we really tell if a unit is good? Do our current targets subvert clinical priorities? How do we provide a more quality-focused regulatory system that supports learning and development?

These are the issues doctors’ leaders should be debating, not Brazilian rainforests or polar bears. While there are people better qualified for this, few are in a better position to help improve standards in our hospitals.

Tags: Basildon, CQC, Mid Staffordshire, Ratings
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Essex hospital failings prompt calls for reform

BBC Health - 8:27 am

Calls are mounting for urgent reform to the way hospitals are regulated after a report found a catalogue of failings at two hospitals in Essex.

The independent regulator highlighted an unusually high death rate and poor hygiene, including blood-spattered kit.

Basildon and Thurrock NHS trust said concerns were not indicative of wider problems, but a taskforce has been sent in to force through improvements.

Most inpatient care is provided at Basildon University Hospital, which has 777 beds, and outpatient care at Orsett hospital in Grays.

The Care Quality Commission (CQC) rated the trust as “good” overall in October. But a new report from an unannounced inspection team carried out by the CQC found evidence of sub-standard care.

The inspectors reported: floors and curtains stained with blood; badly soiled mattresses in the A&E department with stains soaked through to the foam filling; blood-splattered on trays used to carry equipment; items that should only be used once still in use; and, equipment in the resuscitation room that was past the use-by date.

The inspectors criticised a poor care environment in A&E, in particular a lack of privacy for patients. They also highlighted inadequate arrangements to treat children, with few specialist paediatric staff.

The CQC has asked the regulator of foundation trusts, Monitor, to take action.

An expert taskforce will be sent into the trust with a remit to drive rapid improvements in patient care.

47 trusts must improve performance ratings

By Mike Broad - 17th October 2009 4:55 pm

The Care Quality Commission has warned 47 NHS trusts that they must improve significantly over the next year to be allowed to register with the health regulator and avoid sanctions.

On releasing the 2008/2009 performance ratings for of all 392 NHS trusts in England, the regulator said it would be focusing on improving the standards at persistently under performing trusts (see list below).

The ratings, which are developed from information provided by trusts, inspections and audits, reveal a mixed picture.

More patients were seen in A&E within four hours, more received treatment within 18 weeks of referral and more were screened for chlamydia. There were also big reductions in the number of MRSA and Clostridium Difficile cases, and improvement in the financial management of trusts.

Trusts are given ratings from ‘weak’ to ‘excellent’ based on how they score on quality of care and financial management.

Fewer trusts scored ‘excellent’ for the quality of their care compared with last year’s figures. The drop in ratings was worst among acute hospital trusts.

Cynthia Bower, CQC chief executive, said: “The NHS has performed well on quality, which is good news in the face of a rigorous assessment. But it is clear that some trusts are struggling and that some issues are proving tough nuts to crack.

“My biggest concern is those trusts that are ‘weak’ and persistently ‘weak’ or ‘fair’. They must do better for their patients.

“I want to ring the alarm bell in the boardrooms of these organisations. Next year, all trusts must register with us to legally function. It is clear that many have significant work to do and a short time in which to do it.”

Next year, all trusts will have to register with the CQC to be allowed to legally function. They will have to meet basic standards in order to achieve this.

CQC said compliance with core standards is a good indication of whether a trust is ready for registration. Overall compliance with standards increased from 95% to 96%. However, compliance with fully meeting all core standards in the acute sector fell from 69% last year to 59% this year.

If trusts fail to reach those benchmarks the regulator can impose a range of sanctions including prosecution and closing a service down.

Niall Dickson, chief executive of the Kings Fund, said: “The worry is the 32 trusts who year after year fail to meet these standards. Unfortunately, the ratings on their own do not shed light on why some trusts perform well and others do not.

“Patients served by the hospitals and other services that consistently rank at the bottom have a right to know why these organisations are not providing the quality of services that is expected from them. We need to understand whether the problems are managerial or structural, and what is being done to help them raise their game.”

NHS Confederation chief executive, Steve Barnett, said: “It is extremely heartening to see that for the first time ever, more than 100 trusts scored excellent for financial management - at the same time it is concerning that some continue to experience performance issues.

“With the NHS entering the most demanding period of financial pressure in its history the reasons for this need to be understood if the performance of the best trusts is to be reflected across the whole of the system.”