19th January 2015

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Jeremy Hunt in conversation with Roy Lilley

King's Fund 11th February. Details here. Sold Out

You be the judge
News and Comment from Roy Lilley

Has CircleBrooke been stitched up by the CQC? If you read the Daily Mail you'd think so.


It is alleged the Trust has been starved of contracts by a left-leaning CCG, been given a stinker of a report by a CQC inspection team influenced by members of a campaigning group aiming to keep the NHS public and various other shenanigans.


Is it true? Would the CQC be daft enough to skew their inspection team? Are they na´ve or crooked?


What will Circle do? They're a private company with huge investments in health care. A damming CQC report is catastrophic to their brand and investor relations. They could get out of Hinchingbrooke as quietly and as fast as possible; keep their heads down. Hope it blows over.


There is very little room to appeal a CQC report. Matters of 'fact' can be challenged. I hear that is why two prominent, disgruntled London Trusts got busy with their heavy-weight lawyers over disputed pre-publication drafts and the CQC backed down.


Advice to Trust CEOs; shadow and video every part of your CQC inspection and have lawyers on stand-by. Otherwise you don't have a leg to stand on.


Other options? The courts? Judicial Review? Not unless there is 'fault of process'. The other alternative would be for Circle to sue in the civil courts; damage to their reputation.


Would it work? Let's put ourselves in the place of a Judge and look at the report. At first sight the RAG rating looks like a bloodbath. There are 8 reds but 11 amber and 21 greens. Add the reds and the amber together and there are still more greens. The patient survey data places CircleBrooke in the 'about the same' as the rest of the NHS.


The report talks of 'lack of cover' but there are not rotas or staffing sheets I can see to back any of this up. The CircleBrooke management team is described as 'well known' but 'values were not embedded'. How is that measured?


Mixed opinions came for a 30 person 'listening' event; a 'number of people' raised issues. No note of the actual number or the issues and were the 30 representative or anti-privatisation campaigners?


Caring scores are noted as 'average' and CircleBrooke appeared in both the highest and lowest 20% on cancer experience. Let's think about that.  If total national results are exceptional, even the lowest quintile could be world class. If the national results are poor, the English 'best' might be amongst the worst in the world. This is all meaningless.


Bed occupancy, staff sickness, A&E standards are all average. Apparently 'some people' were at risk of harm. How many, who, why? Apple Tree ward came in for criticism, the rest of the wards appeared not to but it was enough for the CQC to condemn the whole hospital as 'inadequate'. The CQC reports 'hearing stories' about poor care. Corroboration or other evidence; there is none.


Pages 3 and 4 are the key pages where just about every part of the CircleBrooke's activity is heavily criticised.


The inspection team didn't like the management structure and it shows. Unlike NHS Trusts CircleBrooke has no Non-Exec's; it's run by a clinically led management team, accountable to the directors of the investment company.


The question is; how did CircleBrooke, in a matter of months, go from being judged the best Trust in the country to dangerous? I was at the CHKS (a highly reputable data analysis company) awards evening and competition from the rest of the NHS was stiff.  CircleBrooke is a boutique hospital with only 300 beds and relatively easy to run.  I have no idea how to account for such a catastrophic slide.


My guess is; it hasn't slid. It was probably neither stunningly good and neither is it now dangerous.  All we can say for certain is; we have no idea and no reliable way of evaluating Trusts and their performance.  Anecdote is not good enough and there is not enough, good enough data,


Right now we are in Bernoulli territory and this morning CircleBrooke is full of patients.  


You be the judge. 


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