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1st August 2016
3

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HealthChat
Ed Smith
Chair of Not-Monitor, or whatever it's called.  In conversation with Roy L
Good conversation, networking and a glass of wine.  What's not to like!
Harry's question
News and Comment from Roy Lilley
We have Harry Longman to thank for this morning's erudition.  He asks:
 
 Quis custodiet ipsos custodes?
 
... Latin, found in the work of the Roman poet Juvenal. It is translates as; "Who will guard the guards?"
 
A philosophical question; how can power be held to account.  It troubled Socrates, Plato and has been picked up in literary themes as modern as Terry Pratchett and Star-Trek.
 
Who watches the watchmen?  Who regulates the regulators?
 
Over the weekend one of the most popular topics for the Twitterati has been the excoriation of the CQC, for their latest blunder.
 
They have managed to lose confidential files containing details of GPs and practice managers who have applied to be practice CQC leads; personal information such as their name, date and place of birth, and apparently mental health information.
 
The CQC hinted 'theft' might have been involved but it seems they've rowed-back from that.
 
If it wasn't so serious it would comical.  Recently the CQC pompously announced that GP practices will undergo 'strengthened' inspections, with practices having to 'demonstrate clear ownership and responsibility for data security'... ouch!
 
My secondary-modern education Latin doesn't match Harry's elegance but this might be near enough:
  
"Populo non saxa coniecit speculum in domos..."
 
People in glass houses shouldn't throw stones.
 
A couple of years ago the HSJ reported;
 
 "The Care Quality Commission has admitted that scores of its inspectors were appointed despite falling short of its own recruitment standards, creating the risk that its regulatory judgements could be "impaired".
 
The CQC admitted they couldn't sack, what amounted to one in ten 'wrong inspectors' because they didn't want to be sued.
 
What happened?  Nothing. Quis custodiet ipsos custodes? No one.
 
Later in that year, the former Chair of the CQC and the present chief executive were sued by a former employee, over the way she had been treated and her reputation traduced.  She won.  Although I had an harrumphy email from their lawyers saying she hadn't won; 'they'd settled'.
 
What happened?  Nothing.  Well, not quite.  The chair ended up in the House of Lords.  Quis custodiet ipsos custodes? No one.
 
The CQC went on to be criticised by their staff for unrealistic working pressures.  More recently they've made a mess of the patient-experts contract and screwed up the appointment of the National Guardian.
 
They've managed to blow their inspection expenses budget, spending 4.4m instead of 1.1m.   What Happened?  Nothing.  Quis custodiet ipsos custodes? No one.
 
I only get 700 words for our daily conversation, already I have used up over half.  I promise you I could use another 700 to make a full list of the CQC's cack-handedness.  Including an unforgivable arrogance over the consultation for their new charging regime. 
 
Like most people who know anything at all about management and the pursuit of excellence, I will tell you; inspection was abandoned as far back as the late 60's as a serious way to improve quality.
 
During the various iterations of the CQC we have seen collegiate inspection, light touch inspection, deep-diving inspection and now 'new look' inspections.
 
The Jim Reaper looks to have all but taken over the running of the CQC and we're to have 'realistic inspection'.  Good enough, is good enough.
 
There is a well-founded evidence base that inspection doesn't work; put that into the hands of an overly bureaucratic, eye wateringly costly, poorly staffed organisation with a Board that don't appear to have a scooby-doo what's going on and you have the recipe for a calamity.
 
The CQC's inspections are supposed to be the story... now it's the CQC who are the story.
 
If the CQC inspected itself it would be in special measures.  The careers of the executive and board would go the same way as they have sent the careers of the people trying to run Trusts and practices with overwhelming demand, not enough resource and unrealistic expectations.
 
The CQC has been destructive, demotivating, discouraging, demoralising and dreadfully badly run.  The new chairman, Peter Wyman, who is a good man, has been in post for six months; long enough to get a grip of this expensive, extravagant, excessive and cocky Board who think they are untouchable.  Quis custodiet ipsos custodes?  No one.
 
My in-box tells me the CQC has lost the confidence of the people they inspect and they would do well to remember another slice of philosophy; we are policed by consent. 
 
Quis custodiet ipsos custodes?  Who will answer Harry Longman's question?
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English Deaths
Patterns of Very Large Shifts
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HealthChat
26th Sept Kings Fund  5.30pm.
Ed Smith 
Chair of Not-Monitor 
(I must find out what they are called!)
Great evening in prospect.  He has a huge experience and a raconteur 
Plus the usual wine and networking. 
Special ticket prices
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Gossip
shh
This is what I'm hearing;
if you know different,
tell me here
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>>  I'm hearing - a review is likely about the conditions under which GPs can refuse to register patients.
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Need inspiration, a good idea or solve a problem
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HealthChat
Missed 
Sir Andrew Dillon's Chat with Roy Lilley
Phil Hawthorn reviews 
'A NICE one'
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