26th May 2016

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Duncan Selbie - boss of Public Health England, in conversation with Roy Lilley
King's Fund - June 21st, 5.30pm - Drinks, conversation and networking 
Our misery
News and Comment from Roy Lilley
Here's a quote:
"We will work with our partners, providers and the public to agree a definition of quality and how this should be measured..."
Guess where it's from?  Yes, it's them again, the CQC, from their 'new strategy document'.  You'd think they might know by now?
There have been a trail of disasters in the life of this tortured organisation yet still it blunders on.  Just over 60% of Trusts are rated by the CQC as, inadequate.
The CQC and their predecessor organisations have been inspecting the NHS since 2003.  Don't you think, if inspection was going to improve quality it would have worked by now?
A little while ago the CQC published the outcome of their consultation on how they are going to make up for the fact the DH has cut their funding.  Their imaginative and innovative response was to ignore the outcome of the consultation and sky-rocket registration fees to fill the black hole in their accounts. 
Pushing their costs into a system, already overheating.  Genius.  The CQC say;
"Over the course of the [next] five years, we will improve our efficiency and effectiveness..."
... unlike the rest of the NHS and care homes who are obliged to do it immediately.
Budget cuts are translated into a new, relaxed regulatory regime, fewer (and bad news for hotels and coach hire companies) smaller inspections.   And, so much for the Tinkerman's promise to 'root out poor care'... hospitals are to rate themselves.
Banjaxed by new models of care the CQC are floundering for ideas.
This is a pitiable document produced by a very poorly performing board... an ideas free zone.  Interestingly, the report's author is bailing out to join the private sector.  So much for faith in the future!
Contrast the CQC with Not-Monitor.  Chaired by the excellent Ed Smith and run by the stunningly innovative Jim-Reaper, they have re-branded, changed the board and chief executive, re-laid the landscape of healthcare, remodelled regulation, redesigned care delivery, restructured their supporting mechanisms, merged two organisations, reappraised their workforce and cut their budget.  All whilst the CQC are palavering about trying to define quality.
This lazy paper (not to be dignified by the word 'strategy', please ), is just horrible and could have been written any time in the 1960's when the failing British motor manufacturing industry still depended on clip-boards and bloke called Harry, in a flat cap and inspection to make some of the worst cars in the world.
Knowing the interest Members of Parliament and Ministers take in the CQC I am gobsmacked that Ben Gummer has allowed this rubbish to see the light of day.  

This is his first ministerial appointment and is a thoroughly agreeable young man of considerable congeniality.  However, this reflects poorly on his abilities to run a crucial department.  He appears neither tough enough nor experienced enough to give the CQC the shake-up it needs.
Gummer wrote a highly praised book 'The Scourging Angel', about Black Death in the British Isles.  I fear this 'strategy' document is likely to be the Kiss-of-Death for him.
All eyes are now on the new CQC chairman Peter Wyman, to see if he is half as good as his Not-Monitor counterpart.  He has a poor hand to play.
As far as I can see, with one exception, none his board have run anything like the 200m a year, mission-critical business that is the CQC.  They seem to be policy wonks and academics.  The Chief Executive, David Behan commands little confidence at the coalface.  It is rumoured; it is the Inspectors who rule the roost.  It is time for Behan to move on.  
In the early 2000's inspection was the political response to the Bristol Baby debacle.  At the time there was little data, few analytics and almost no software; inspection was the only recourse.
Since then the world of quality assurance has moved on but the CQC is marooned in its own autolary.
It is time ministers realised this is 2016 and pushed for the answer to the only question that matters; 

'How did we do today?'.  

Real-time answers.  It can be done.  I sense the CQC haven't the first clue how.
The inextricable but complex links between funding, demand and quality are well rehearsed.  The failure of 2/3rds of Trusts to meet basic standards is evidence enough.  The curtailment of even the rudimentary quality assurance activity of the CQC creates the meteorology for the perfect storm.
The CQC are out of ideas, out of date and out of sorts.  It's time they were put out of our misery. 
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Important changes to the way the numbers are counted.
OECD, Eurostat and WHO have a new, unified methodology
Social care and health public and private spending are rolled into the numbers.  This has the effect of pushing up 2014 to 9.9% GDP, previously it would have been 8.7%.
We are now the same as Austria and Belgium but below France and Germany.
More on the detail here.
Clear explanation with graphs here.
Thanks to Anita Charlesworth and Ben Gershlick from the Health Foundation for the heads-up
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Duncan Selbie
Chief Executive Public Health England
In conversation with Roy Lilley
21st June - King's Fund 5.30pm
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