Yesterday we had a shemozzle with the CQC, over one of their reports. Later in the day it emerged over half of CQC reports are more than 50 days old (Page 19) before they are published; some could be 70 or 80 days. Well past their read-by-date.
Regulation is painstaking but clunky and writes history when we need news; gives us information when we need real-time data to act upon. Common-sense tells us the CQC is not stupid or lazy. They've had 5 years to sort this out. The size of the task grown beyond them.
Since the Health & Social Care Act a lot has changed. The financial climate, attitudes, leadership and priorities. Competition has given way to collaboration; care pathways have opened conduits across boundaries.
We now realise Trusts, surgeries and care homes are often prisoners of geography and forces beyond their control, rather than hostages of incompetence. Regulation all but superfluous. If the CQC didn't exist we wouldn't invent them. The same is true of Monitor.
Monitor is about to devour the TDA and morph into a 'transformational' thingamabob. Practical and sensible; aimed at improving provider side performance. Show them what good looks like and how to achieve it.
Monitor's problem; identical to the CQC. Making things better is not really their job. Monitor exists to regulate a competitive healthcare market that no one really wants and the fag-end players want out of.
Circle have bombed, Serco pulled out, Bupa out of a partnership deal and SAGA out of hands-on care. Virgin? Who knows? If the NHS can't make ends meet I can't see how a company can make ends meet and make a margin.
Pretty much, since leaving school, I've worked for myself and run businesses. I can say, with the scars of experience; if you can't make a margin you don't have a business.
Making money isn't necessarily about spending it on a fur coat for the mistress, or a new Lamborghini. It's having enough money to make a 'margin'; repay borrowings, reward shareholders, encourage staff and invest to develop.
From my perspective there is no money in patient facing care services. Only disproportionate risk to balance sheets, reputation and brand. Tariffs are squeezed and will get tighter. As Shire found out, fees will get slimmer and the pickings slimmer still. Next year a further 7% cut is on the cards.
My prediction; what is left will become more contested. We discovered last week; Care UK has been branded a 'bad loser' after lodging a complaint with Monitor over the management of a contract by a North London CCG.
Care UK is grumbling that wrong criteria were applied in awarding a contract; too much emphasis on price and too little weight on quality.
I deduce Care UK were not the cheapest bidder! If I'm right, the message for Care UK is; 'get real'. Quality is a given. These days it's all about price.
The upshot; the CareUK complain they have been hard done by. I suspect, few tears will be shed for them and it's a silly move. If Monitor were to unpick the deal and award the contract to Care UK; who would want to work with them? Bad move... throwing the brand out of the pram.
Nevertheless, I understand. All private care partners face watching their businesses prospects going down the toilet. There isn't any money!
That's where Monitor comes in. Their fruitless task; to support market drivers when they, we and all of us know the future will come from teamwork.
However, collaboration, alliance and partnership are very likely to limit choice and focus a narrower access. That is not what Monitor exists to facilitate. Quite the opposite.
My take on the Vanguards is; setting aside the obvious benefits of innovation, collaboration, streamlining and service improvement, it is possible to pick a competition, choice and access argument with most of them.
Monitor has to do what it says on the tin; regulate. If they don't, the real regulator, the Markets and Competition army, will step in. If they don't step in, the European competition authorities will put the boot in.
As healthcare becomes more nimble and fit for its purpose, driving new services and ideas, regulation is parked. In 2006, Labour's Home Secretary, John Reid, made the unprecedented criticism that his department was 'not fit for purpose'.
My question; what is a Conservative health secretary ready to concede?
