You have to go with your beliefs.
I believe the only way to get good at something is to find out what the best looks like and try to do it, better.
I believe that if you put your heart and soul into starting with the 'customer' and working backwards, you won't go far wrong. Don't wrap the customer, or in our case the patient or resident, in what you are doing now and call it the best. It's lazy, too easy, too cosy, too comfortable.
All my life I have believed that most people come to work and want the time and space to do good things. I believe it was my job to create the environment where it can happen.
I believe the idea that we can make the NHS better by coachloads of people descending on it, demoralising everyone, watching good people walk away from the wreckage and claim it's a success, is a deception and a fraud.
My concerns about the CQC are well rehearsed. The concept of NHS inspection started in the early 2000's. Years later I don't believe we are any better off.
I believe it impossible to improve the quality of anything by inspecting it. I believe you know it's true, too.
At the CQC's last Board meeting a paper was tabled, listing risks to their organisation arising from the changes it faces. The implications amounted to:
* Reduction in CQC's budget or in the budgets of the services we regulate, impacting our capacity to deliver our commitments, and the potential for improvement to take place in the quality of care
* We do not have an impact and are unable to encourage improvement
* We are unable to deliver the changes set out in our Strategy due to being unable to agree or deliver joint approaches with partner organisations
* We do not have the skills and capability we need to be able to regulate effectively
* We are unable to manage our costs within our reduced budget and we overspend
In plain English, it is very astute and very candid. They are saying; they are worried that there isn't enough money in the system for them to do the job and even if they could, no one has enough resource to do anything different and anyway, no one cares any more. Sixty percent of Trusts have some sort of an issue.
They also mean they can't recruit and even if they could the NHS with porous boundaries between new models of care, social care, community, primary, voluntary care, LAs, Vanguards and all the rest, is too complex to 'inspect'.
They are saying they have no real idea how to cut their cloth.
Sensibly, they have a risk register. It is the first RAG rating I have ever seen, from a national organisation, with no green.
I don't have enough space; you'll have to read it for yourself. Mitigation still leaves the CQC in a sea of amber;
"..robust this and that, controls, reporting, challenge, definition, planning, KPIs, enforcement, monitoring, data cleansing, prioritising, improvement actions..."
...just about everything they should be doing now and none of it likely to work a turn around.
The issues around new, complex models of care are intriguing. Are they too complex, making them impossible to regulate?
Does that mean we abandon innovation because new services cannot be 'inspected' or do we abandon regulation? The CQC look very flat-foot.
Look what Not-Monitor has achieved in the same time scale. They have reshaped the NHS, remotivated everyone, are full of reassurance, ideas and challenge.
The laws of physics tell us, objects with mass have the force of gravity pulling in on itself. Unless there is a balancing force the object will collapse under its own weight.
The CQC is collapsing under its own mass; its size, cost and bewilderment. There is no balancing force. No success, no popularity, no evidence, no obvious way for them to continue their orbit.
I believe this is a sinking ship.
The CQC strategy document, we spoke of the other day, is disconnected from the risks and amounts to more of the same. They have one foot in the grave. If they were a pork-pie they'd be past their sell by date.
The CQC are the one-legged elephant in the room. They simply cannot be allowed to continue.
I believe it is time for Ben Gummer to act, the Health Select Committee to wake up and the rest of the NHS to walk away.
