When I was a kid we used to send each other secret messages.
Squeeze the juice from a lemon, get a proper pen (one with a metal nib and a wooden handle) dip into the juice and write the message between the lines of the page of a book or an ordinary letter and the words are invisible.
To make it reappear; warm the page near a light bulb and what's written appears in brown writing.
In the years of the Cold War; standard operating procedure for spies! Cryptography at the leading edge.
Maybe that's where the phrase 'reading between the lines' comes from.
I confess I am reading between the lines when I tell you I think the skids are finally under the CQC and the NHS may be in the grip of common-sense.
In an excellent article in the HSJ, by David Williams and Lawrence Dunhill, the Grim Reaper is interviewed about the CQC.
Jim says;
"... there had been "misinterpretations" of CQC recommendations by Trusts."
I can only congratulate the Reaper on his diplomacy! A new found tact! 'Misinterpretations'... really!
We all know the CQC is the most damaging organisation in healthcare. It costs a fortune, intimidates, bullies, is clunky, slow and has cost umpteen, very capable NHS leaders their careers.
Standards are made up, they have tried to recruit and can't, over-run their budgets and made a mess of more inspections than they are prepared to admit. If any organisation was deserving of special measures it is the CQC.
It looks like the Jim Reaper is about to give the CQC a reality check.
He told the HSJ duo;
"...where (CQC pressures) ... led to trusts being in financial difficulty... NHS Improvement would be "brokering conversations between the CQC and the trust that gets everyone in a better condition".
You don't have to read between the lines here. In other words; butt-out, grow up and get into the real world.
The Reaper speaks of one Trusts where, with his support, they had decided not to follow CQC recommendations on the grounds that it would cost too much and 'not essential'.
The Reaper says;
"... in future, CQC recommendations should be balanced against cost implications."
There are two ways of looking at this.
- The NHS doesn't have enough money to do quality or...
- The NHS has been pushed into a corner by an overzealous CQC, intent on making a name for itself.
These competing arguments will come to a head over safe staffing.
The Jim Reaper is saying;
...Trusts exceeding the 1:8 nurse to patient ratio could be told "we can't afford that".
The growth in staffing is a result of the forgotten Francis Inquiry, the CQC using the ratio as a yard stick and a beating stick and the service completely confused by the hokey-cokey, between the DH and NHSE.
NICE produced the original safe staffing guidance; what a joke. Centred on the idea that 1:8 was ok, provided somebody could wave a 'red-flag', (if medicines were late or patients were waiting to go to the loo) and additional staff summoned.
Try that on a Sunday afternoon when a medical ward has three frail, dementia patients delivered and the rest of the hospital is crammed full.
NICE guidance was based on the work of Anne Marie Rafferty et-al, who never said 1:8 was safe. It is not. It is the margins of safety, at the limits and the ragged edge where few of us would want our relatives.
The Jim Reaper has run a trust and well understands the risks that pressured, exhausted, distracted, overworked, under resourced wards run.
Every shift that ends without an incident is a lucky escape.
Let's not pretend otherwise; this is a high risk strategy brought about by pressures of finance from a panicky Treasury, hell-bent on gripping the nation's finances, ready for a post Brexit buffeting.
Keeping the NHS as dis-aggregated, single entities, Lansley's chaotic legacy, is no longer viable. Health economies must be viewed as a whole, pooled staffing, consolidation of back-office and some front of house services is urgent. Coalescing clinical expertise in centres of excellence is a job to get on with.
The plethora of CCGs are an indulgence for GPs, as are a dozen other organisations that are a luxury at a time when every penny of non-essential expenditure must go, with a relentless purpose; to keep the front-line safe.
This is one message that is not a secret; it's time to circle the wagons.
