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
Lansley is talking about measuring outputs rather than inputs, so maybe that will reduce the amount of regulation (or am I a victim of wishful thinking).
Absolutely right. The CQC came to my private hospital with their clip-boards and automatons strutting around and issued dictats left,right and centre for which there is NO hard evidence whatever. For example, they demanded that names of patients be removed from all ward bed lay-out whiteboards on the basis of “patient privacy”. So now we cant find our patients when we arrive without searching for the single hard-pressed nurse who’s invariably cooped up in a patient’s room. Meanwhile names continue to be used in NHS hospitals and in hospitals all over the Continent.
The problem is that these CQC people are SO powerful that the private sector would rather kow-tow to them than demand the evidence that they fail to provide when laying down their ridiculous rules. This is a serious situation and Tom Goodfellow does well to highlight it. But there’s been a curious passivity amongst our profession over the past 10 years which has allowed us to be trampled upon in so very many ways, and one wonders whether we have the stomach to resist anything anymore!
There are too many sledgehammers to crack a few miniscule (or even non-existent) nuts. The problem is that the sledgehammers are designed and produced by ‘nuts’. Doctors are highly educated (at great expense) people and specifically taught to assess ‘risk’, to reduce ‘risk’ to the minimum practical and, in every single ‘case’, to TAKE RISKS - for no disease, and no treatment, is WITHOUT risk!
A recent example of stupid ’standards’ is that carers are supposed to wash their hands between patients (good) - but they are to sign to record the fact that they have done so (bad) - no doubt with the same ‘dirty’ pen they use all day! Do they not realise that this takes TIME (and, therefore, costs money) which would be better spent giving care to (or ‘bonding’ with) patients? Do they not realise that such an ‘order’ will put some people off washing their hands?!
When will doctrine-writing do-gooders allow professionals (people who are far more knowledgable and experienced than them) use their JUDGEMENT?
Tom Goodfellow raises some interesting points. Honora O’Neil’s enlightening Reith Lectures of 2002 came to the depressing conclusion that the more regulation we introduce and the more “apparent” transparency we pretend to show in compliance, the more this becomes a charter for the idle, incompetent and cynical! The late Ivan Illych talked in his book “The Medical Nemesis” about diagnostic imperialism-or the invasion of medical care by managers, nurses, pharmacists, physiotherapists and anyone else who has the confidence to blag their way into the doctor’s role….how prophetical. The big problem with us doctors is that we will never agree with anything any of our colleagues suggests.