15th May 2015

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Dr Mark Porter

In conversation with Roy Lilley - this is warming up to be a really good 'conversation'!

Chair of the BMA - just how relevant is the BMA; does anyone listen to them?

Health Chat at the King's Fund 18th June Details here.

New Game
News and Comment from Roy Lilley

I stand to be corrected but for me, the best ever move was in the Petrosain - Spasskey world championship in 1966. The King's Indian Defence, Fianchetto, Panno Variation Blockade Line, White Queen to H8 and in 30 moves, mate. Cunning and unexpected.


Politics is very like Chess. Full of cunning moves.

Just how cunning are the moves around David Prior? He has left his role as Chair of the CQC, given a job as health minister in the House of Lords; replacing the much admired Freddy Howe.

Howe is smooth operator and a joy to watch. Methinks Prior is not. Prior it not without talent, the greatest of which is probably his ability to put his foot in his mouth whilst already having the other foot in his mouth.

As the coalition government was doing its best to pacify an NHS beside itself with angst over the H&SCAct, Prior told the newspapers that failing Trusts should be sold off to the private sector.

Prior is a former Conservative Party deputy chairman, son of a Cabinet Minister, chairman of Norfolk and Norwich University Hospitals FT and was ousted as an MP by Noman Lamb.  Prior is a Grandee who has to be treated with kid gloves.


What are we to make of this?


Freddy Howe played a pivotal role in patiently steering the Lansley hotch-potch through the Lords. Prior, who succeeds him, is not in that class. Are we, then, to assume the Tories plan nothing controversial in the way of legislation and Prior will be a bench sitter.


If there is another controversial Health Bill there will be an almighty row and Labour and Lib-Dem peers will eat him for breakfast.


Why move him from the Flat-Earthers? On his watch hospitals, surgeries and care homes are no safer. Elderly people uprooted and moved, inspection is longer, more complex. Reports are repetitive (Not enough staff and drinking glasses out of reach blah, blah), with no sign of improvement; half of Trusts in problems.


Ill-qualified staff have been recruited and the CQC fearful of a row with tribunals, left them in post. Reports take ages to write and out of date when they surface.


Chief Executives are hacked-off. So much so, I hear the increasingly brittle Behan is inviting ChExs to dinner, trying to get them onside.

The CQC is greatly admired by hoteliers up and down England who are making a small fortune billeting armies of inspector's descending on their local hospital. Sadly, not admired for making services better.

At a time when the NHS has no money I estimate the CQC has pushed up provider costs; extra staffing, recruitment costs, training, inspections, rehearsals, consultants, paperwork, analysis, meetings, conferences, hotels, subsistence, back-filling, management time, decorations, new kit, calibration, polishing and feather dusters.  Add it up and you must get close to a £billion worth of costs in flow.

The CQC is getting fatter the NHS is getting thinner and patients are getting squeezed in the same gaps in care they were 15 years ago when inspections started.


Let's not put too fine a point on it; it looks very like Prior has got the sack. In a careful move, as subtle as anything you will see on a chessboard, Prior has been parked. He has no overwhelming talent for the House of Lords. He has just made a mess of the CQC and because of who he is, has been let down gently.


What next for the CQC? Well, it can't carry on as it is. It is a laughing stock. Chief Executives make jokes about them and go off to rehearse for their arrival. My inbox is full of complaints and anecdotes. Everyone, at a time of NHS austerity, wonders what the return on investment is.


Jeremy Hunt may be a lot of things but he ain't stupid. He knows this can't carry on. When I quizzed him about the CQC he defended them like a Premier Club Chairman gives his support to a losing manager.

Who will replace Prior? No one. No one with any management knowledge or experience. No one with self-respect. No one interested in safer care. It is the wrong question. The right question is how long will the rest of the Board stay and what will replace the failing CQC?


Will it stay the biggest bookers of hotel rooms and charabancs? Or will they become world-class data analysts. Will they create audit families of similar organisations and benchmark performance. Will they publish real time data from CQC dashboards. Will they do all this for one fifth of what they cost now?


Hunt has made way to clear the board and knows he must start a new game.

Have a good weekend.



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