In 63BC the great Roman philosopher and poet Cicero wrote “The welfare of the people is the supreme law”! Since then public and private bodies have been regulated to protect people from intentional or un-intentional harm, especially appropriate in health and care.
I don’t question whether NHS regulatory oversight needs to exist but rather to ask if the current bewildering maze of regulatory bodies does the job well?
It’s clear that the answer is no, especially as the present NHS regulatory system isn’t a system; no interconnectedness, nor shared common purpose and values, language that is not transportable from one part of the system to another, and perhaps above all, implies that someone somewhere can evaluate the totality of this regulatory activity.
Even before Cicero, the question “Quis custodiet ipsos custodies” -; who regulates the regulators was being asked? Is the NHS answer, nobody?
Despite Mid Staffs, Southern Health (et al) and the inquiries which followed, I uncovered events that took place at Liverpool Community Health NHS Trust (LCH). Events that, whichever regulatory issue is used, defies belief and shows the utter lack of cogency between the (too) many agencies that were responsible for the safe, efficient and effective monitoring of LCH.
Not one, not one of the regulators and commissioners, NHSI, NHSE, CCG, CQC, NMC, GMC saw that lives had been lost and people injured because of the confusion that is today’s NHS regulation. It needs to be much simpler.
Between 2011-2014, LCH relentlessly pursued foundation trust status, with the Trust Development Authority (TDA) in 2013 considering the Board to be sufficiently strong to move on to the Monitor phase of ‘the pipeline’. Ironically, this was at the same time as staff were reporting bullying (94% of staff said they had witnessed incidents of this in the staff survey) and soon a CQC visit piloting the new inspection model found the trust to be ‘Room for Improvement’ despite the report appearing like a clear inadequate.
At the heart of this is the conflict between regulators with differing priorities – TDA pressing to demonstrate progress on the fabled pipeline, Monitor incapable of questioning quality, obsessed with financial governance (look today at the financial state of most FTs!) and the CQC in the wings with no real forensic mechanism to analyse community service quality and CCGs at the time more interested in examining their navels than doing their jobs. The upshot of this is a set of events, with terrifying impact on patients and staff that have been catalogued by Bill Kirkup in a review published here https://improvement.nhs.uk/documents/2403/LiverpoolCommunityHealth_IndependentReviewReport_V2.pdf in 2018.
If the unification of TDA and Monitor as NHSI was to be an improvement then LCH proves two turkeys don’t make an eagle!
In removing the CEO of LCH, NHSI continued their bad habit of recycling problem people in the NHS.
It took NHSI four years to find a final and stable home for LCH services.
Non-executives who had evidently failed were left in post by NHSI creating a power struggle with the interim team, delaying progress while patients and staff continued to suffer.
In a two year ill-fated NHSI procurement process LCH services were split 13 ways and tendered to 8 different organisations, creating continuity and stability issues. Meanwhile the Monitor component of NHSI was developing integrated care licence conditions ensuring no trust could act in a way that would be detrimental to enabling integrated care. Simply mind-boggling.
Then NHSI’s transaction team (many of them recycled or retired from trusts) awarded the main contract to Bridgewater NHS FT in conjunction with Liverpool City Council and Liverpool GP Federation despite the fact that Bridgewater and LCC were struggling financially and the GP Federation had no management track record whatsoever and both NHSI and Liverpool CCG knew that Bridgewater was to be rated ‘Room for Improvement’ by the CQC and should be ruled out via the NHSI transaction manual.
While seeking clarity on this debacle, I watched NHSI, Liverpool CCG and to some extent the CQC pass the blame between one another. NHS England, with responsibility for the approach and work of CCGs was nowhere to be seen. I await the findings of the National Audit Office review into the process and costs associated with this transaction.
The former CEO, Finance and Workforce directors have all moved on in the NHS or industry without anyone associated with this damning episode formally being held to account and it has been left to me not the regulators to pursue it.
The Chair and all but one of the non-executive directors refused to speak to the Kirkup inquiry? Why?
The events that permitted LCH to spiral so disastrously are not unique, not even rare. Instead, they are being played out often, even if not in the amplified way that occurred in Liverpool.
Regulation in the NHS is failing because there are too many organisations with fingers in the pie. I intend to seek support for a single oversight framework, using common and simple language, and a reduction in the number of regulatory bodies.
This is important because, as a health select committee member and MP, it has taken five years to expose the wrongdoing of those associated with LCH. So what hope has the vulnerable, harmed citizen got to ever redress the balance? It’s time to get real!