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11th December 2015

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News and Comment from Roy Lilley

I've always regarded Lord Prior, the sinecure health minister in the Lords, as somebody the French would describe as the Le Grande Plonkuer.

He is the one who wanted to sell failing hospitals. He seemed he could only speak when his foot was in his mouth.

However, he seems to have undergone something of a Damascene conversion. In an excellent HSJ piece by David Williams, he said this:

"In the absence of a market, we need intelligent transparency to reveal variation and drive improvement."

Blimey; he's woken up to the fact that Circle lost their shirt and Ł7m trying to run a Trust, Serco have pulled out of patient facing care, BUPA have taken their ball home and half of care homes are on the brink of financial ruin.

The health and care services are running on the smell of money and there are no margins to be made out of vapour.

Prior went on to talk real sense about the merger of the TDA and Monitor:

"It is not just about bringing together the two organisations, it's creating a new organisation with a new purpose: to support providers to improve."

He is right and he is wrong. He is right; the new organisation should focus on helping organisations improve. I agree. Where he is on less sure ground is that no new legislation is planned, thus Not Monitor & Co will still be mired in competition policy and legal guff.

The extent that Not-Monitor will be able to circumvent their legal duties will be the real test for Ed Smith and Jim Mackey, the new Bots Elite Transformers and Ministers' willingness to support them.

More carrot than stick? Mackey's dire warnings , at yesterday's HFMA conference, about busting the Department's expenditure limits, looks like there could be a lot of stick to me.

Nevertheless, I detect a determination across the Carbuncle and the DH to ignore the Lansley Legacy and work around his wreckage.

Trusts are not failing, not if the majority can't balance their books or quality and safety is forced into doubt because they can't hire nurses. That is system failure.

Failures made worse by tagging hospitals with the sobriquet 'failure'. When it becomes impossible to hire staff and experience walks away, that is a national emergency.

Let's wish Not-Monitor&Co well in their endeavours. If they are interested in the good stuff, so are we.

With the Carbuncle providing new system leadership and Not-Monitor & Co looking to show us what good looks like, we are still left with the third of the ugly sisters; the dysfunctional CQC.

For 16 years we have employed inspection as a method of improving quality; what have we got?

A bill for Ł200m a year, reports that are delayed for months, inspectors erroneously recruited that the CQC dare not sack, budget over-runs, the cost of inspecting Trusts running into +Ł300k a go, demoralised and harassed staff and three in four Trusts 'failing' to meet their made-up quality standards.

Oh and a bow-wave of complaints, a cacophony of blown whistles and the CQC frozen like a rabbit in the headlights.

This is system failure compounded by organisation failure made worse by what I see as a failure of the Board.

The CQC now have a new chairman Peter Wyman.

Fundamentally an auditor, accountant and a partner at PWC. I can feel your joy!

Wyman served as special adviser on taxation and deregulation to the under-secretary of state for corporate affairs between 1993-94, a member of the Deregulation Task Force between 1994 - 97 and external overseer of the Inland Revenue/Contributions Agency Joint Working Programme between 1995 - 98.

He was also President of the ICAEW during the aftermath of the Enron scandal between 2002-03 and was a member of other committees and working parties, including chairman of the Professional Standards Office (1999-2000) and Deputy Chairman of the Financial Reporting Council.

As you can see he is an expert on motivation, inspiration, good stuff and quality... and another white middle-aged bloke. Groan.

But, look on the bright side... he can add up and may make the CQC stay within budget, perhaps?

In fairness he was the chair at Yeovil FT for a while.

The CQC is the last unreconstructed dinosaur of the Lansley era. Everyone knows they simply cannot carry on clod-hopping around the NHS eating money, destroying morale and extinguishing careers.

'Failure' is their status quo. We all know they have to do something more than turn up with a bus full of inspectors and make local hotels rich.

Well, fingers crossed, we are about to find out if Wyman can do more than add up.

Have a good weekend.

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