10th February 2015

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Important Change of Time for Wednesday's Health-Chat with Jeremy Hunt

Brought forward - Kick-off now 5pm to accommodate SoS's commitments.


Health-Chat with Roy Lilley 

Dr Sarah Wollaston MP Chair Health Select Committee

11th March - King's Fund 5.30.  Details here.

News and Comment from Roy Lilley

It's OK for organisations to use their best endeavours, try hard and make a mess of things. It's not making the mess that's the issue. It's pressing on, taking money for doing a job, knowing it can't be done, that is not honest. I think the CQC have got to that point.

A BBC Radio 5Live investigation revealed one in five care homes are 'failing'.

In October the CQC introduced a new inspection regime. The BBC reviewed 9,816 inspections carried out under the new, all-singing-all-dancing regime. Nearly 2,000 homes were not fully compliant and 3,500 people are living in 96 homes which failed to meet any of the key tests.

Debbie Westhead, the deputy chief inspector for the north region, said; the figures were not "good enough". Yes Debbie, you are right. Her problem; short of closing 96 care homes the CQC can only huff and puff.

It is no longer honest for the CQC, its Board, David Behemoth and the rest of his flat earthers to pretend that the CQC is making an iota of difference to the quality of care for our most vulnerable.

Inspection does not contribute to quality; Deming said it, Porter said it, Peters says it, Handy says it and last week the patron saint of healthcare safety, Don Berwick said it. Only ex-Tory MP, David Prior, chair of the Labour chimera, the CQC and his board, persists with this charade. Through impotence the CQC has become the story.

I was relived beyond relief to see that LaLite is finally trying to move the pursuit of quality on; shifting the emphasis to analysis... Case Note Reviews.

Medics will sample 2,000 cases. There is a codicil; results will be extrapolated and turned into some form of ranking system. That's daft but plays well in the press in the run up to the election. I forgive him.

CNRs are the gold standard. They are expensive, time consuming and not without controversy; which method, holistic or criterion-based. And, death may not be an indicator of poor care. CNRs must be carried out consistently and 2k is nowhere near a big enough sample. But, I hope it is the start of a new era for the NHS; 'non-threatening learning'.

The whole approach is complex - nicely summed up by Dr Roger Steadman, here.

CNRs have been triggered by the performance of 'special measures' Trusts who found themselves first identified by the analysis of data. Data that was not perfect but, as Uncle Bruce says; 'they are the smoke'. Data-doyen Sir Brian Jarman, often the butt of ill-informed criticism as to his intent, is right; Hospital Standard Mortality Ratios tell us something. You can never be sure quite what, but it says 'listen carefully'.

This is a giant leap for hospital safety. Well done Jeremy! (Blimey, never thought I'd say that!).

Note; this step change achieved without sending 80 strangers to a hospital, under the direction of a cancer doctor with no management qualifications, to wander about, tell us 'they saw an empty drinking glass out of the reach of a patient' and 'there are not enough nurses'... all for the bargain price of 250,000 a pop.

The Trusts, in Uncle Bruce's special measures group, had high mortality rates some of which have improved. Why? Regression analysis shouts 'special measures has nothing to do with it'; the 11 Trusts were not randomly selected, no control group; they may have improved anyway and there are new examples of poor care emerging, elsewhere, all the time.

The reason they have 'improved' is; they have had more money, shared expertise and beefed-up front-line staff. We know the ingredients of good care. The CQC is irrelevant.  Do that everywhere and you get better care. 

We know crappy care homes, in an unconsolidated, largely momma-papa shop industry, operate at the margins of solvency. Driven to the edge of the edge by the likes of Birmingham Council who commoditise care-places, auction them and award contracts to the lowest bidder.

In our old age, the best we can hope for is to be looked after by the cheapest person they can find, in the cheapest place still open. 

Lalite's quality epiphany is to be cheered to the rafters. His next job; close the CQC and use the 100m their activities consume, for front-line care... not on another game of CQC Bunco.


'What is the point of a select committee' come and join me in conversation with Dr Sarah Wollaston MP, chair of the Health Select Committee.

 Kings Fund 11th March - details here. 


  Contact Roy - please use this e-address


Know something I don't - email me in confidence.

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11th March - Kings Fund
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