26/06/2013 Leave a comment
Poor Standards, cover-ups and scandal seem to be swirling around that most beloved institution, the NHS.
One of the most fascinating thing I have been involved in over the past few years is learning about this thing called the NHS, for it is not one thing but a vast collection of organisations often competing with itself and local government, it is extremely complex and ‘eats’, after welfare, more of our nation’s money than anything else and more than the entire cost of Defence, Local government, Home office costs and overseas aid put together.
The latest scandal is of course the Care Quality Commission (CQC) cover-up and its interesting watching David Behan, it’s new Chief Executive, a former local Government Director of Adult Social Services and latterly chief civil servant to successive Care Ministers deal with the political and public fall out. Somewhat less visible has been the organisation’s new chairman David Prior, which is a surprise given his political background, it’s interesting and such a small world that he lost his North Norfolk seat to one Norman Lamb in 2001 by just 483 votes, who of course is now the Care Minister.
I recall a few years back the reformed CHC coming to a meeting in Endeavour House, Ipswich and telling us of the scope and scale of the organisation going forward and how the new regime was about simple registration of Care Homes and Health organisations and how this process would ensure standards. I and officers left that meeting ‘gob-smacked’ at what was being proposed and perhaps what we are seeing today is a direct result of those decision taken then, in essence I think we have seen an organisation trying to step up but with extremely limited resources. I have met with David Behan on a number of occasions, particularly around the challenge of the Dilnot reforms and if anyone can move that organisation forward it is him, provided he is given the resources with which to do so.
Indeed if, and I have, you have ever read one of their reports it is clear that the process is far from robust and often anecdotal at best. There are some commentators who are saying that one regulator going forward who covers social care, primary care, dentistry and hospitals is ridiculous. I don’t agree with that but do say that what is ridiculous is the level of funding provided to carry out their function. To say they are thin on the ground would be something of an understatement, in Suffolk they have two part timers covering the whole system, a system that employs tens of thousands of people and spends a collective £1.5Billion. How do two part timers hope to meaningfully report.
So what we have is a swirling bubbling pot, add to the truly shocking Francis report about hospitals and the clear blueprint he proposes for change both in our hospitals, their accountability to patients and indeed the role of Local Government Scrutiny; next add in the new Healthwatch organisations and Health and Wellbeing boards and it is difficult to see what we will get, how do we create a robust system of monitoring and checking not only to make sure our hospital and health system is safe but actually drive forward improvements.
Sometime ago at the creation of Police Commissioners I blogged about the notion of Health Commissioners, the care and health system is vastly more complex than the police service, vastly more important to most people’s daily lives, collectively it spends, in Suffolk alone, about 1000% more than the police service and yet is for the main part at the local system level is essentially democratically unaccountable. I think to improve and move forward an important element must be meaningful local democratic accountability. I continue to pounder that a Health Commissioner would have the democratic mandate and accountability to pull all of this vast complex system together at a local level for the better. Mind you what a job!