The Care Quality Commission Cover Up – and the biggest cover up of all in the NHS Dr Raj Persaud and Dr Peter Bruggen

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The Care Quality Commission Cover Up – and the biggest cover up of all in the NHS

Dr Raj Persaud and Dr Peter Bruggen

DSCF1579The Care Quality Commission has now named its officials who are alleged to have been involved in a cover up of an internal report critical of the CQC’s monitoring of Furness General Hospital.

Health Secretary Jeremy Hunt has tweeted in response to the naming of the officials: “Pleased to receive CQC letter naming the individuals involved. Clear sign NHS is changing. We must have accountability throughout the system.”

It is reported in The Daily Telegraph that Hunt will today say that the names of the doctor and nurse ‘ultimately responsible’ for a patient should be placed above every hospital bed in Britain.

We detect an attempt to shift blame away from poor NHS and regulator leadership, towards doctors and nurses struggling at the coal face often under impossible conditions. Searching through the biographies of senior managers of the Care Quality Commission, past and present given the current turmoil and turnover, it is difficult to find anyone running the body in charge of checking standards of care, who worked as a doctor or nurse in the NHS.

Jeremy Hunt may want the names of doctors and nurses ‘ultimately responsible’ for patients above every hospital bed, but why should the Chief Executives and members of Trust Boards not be there as well?

Or would the list of people, including bureaucrats and administrators who make life and death decisions over allocation of funding and running of services, also surely ‘ultimately responsible’, become too huge and unwieldy?

Maybe that is precisely a fundamental problem with the NHS today – the sheer size of the bureaucracy and the widening distance between those who run it and the patients they are meant to be caring for.

A fundamental conflict that remains covered up in the NHS is the divide between what kind of health care doctors believe should be delivered to patients, and what administrators are prepared to. Because doctors are employed by the NHS, the public may be confused into believing that the health care they receive at the hands of their doctors, is what the medical staff want to provide. Far too often it isn’t.

Gianluca Veronesi, Ian Kirkpatrick and Francesco Vallascas of The University of Leeds, have recently published a study examining the number of doctors on the boards of Trusts in NHS England. They were partly prompted to conduct the study because the number of clinicians involved in the strategic governance of hospital trusts in the UK, is relatively low by international standards.

The study entitled ‘Clinicians on the board: What difference does it make?’ found that a higher percentage of clinicians on NHS Trust boards leads to higher quality ratings of service providers, especially where doctors are concerned. Across England, an NHS Hospital Trust’s position in the league table, could be determined by how many doctors were on its board. Trusts in the bottom 25%, compared to those in top 25% in quality of care, had a 10% difference in the share of doctors on the board. Adding 10% more doctors meant you moved up the table dramatically.

The authors of the study points out their investigation, and others, confirm only very limited progress has been made in recruiting clinicians onto the boards of NHS hospital trusts.20130310_111348

This is despite the fact impact of clinician board members in the NHS appears to be considerable. Even a small increase in the number of doctors on boards (10%) can have marked consequences for hospital outcomes, according to their study.

Notwithstanding the importance of nursing in the delivery of care services, this study found that the influence of nurse directors of NHS Trust performance was negligible, unlike the impact of having doctors on boards.

Amanda Goodall, Associate Fellow, University of Warwick, recently published a study looking at the top-100 U.S. hospitals in 2009, as identified by a widely-used media-generated rankings of quality, in three specialties: Cancer, Digestive Disorders, and Heart and Heart Surgery.

The personal histories of the 300 chief executive officers of these hospitals were then investigated and The CEOs classified into physicians and non-physician managers. The study, also published in the academic journal ‘Social Science and Medicine’, confirms an extremely strong positive association between the ranked quality of a hospital, and whether the CEO is a physician or not.

The study entitled ‘Physician-leaders and hospital performance: Is there an association?’ concludes that US Hospitals positioned higher in quality league tables are much more likely to be led by medical experts rather than managers.

Not only NHS Trusts, but a large number, if not all NHS and related institutions, including the Care Quality Commision don’t have many doctors and other clinicians present in terms of leadership.

The public should be aware of who really is issuing the prescriptions in the NHS.

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