State of reflection

James Gubb, 11 December 2008

It’s not often that you read a document produced by a regulator that actually has genuine feel behind it, but The State of Healthcare published by the Healthcare Commission today does. The dynamic of the text is a lesson, almost, in making a subtle political point. The tone is reflective and conciliatory (though, inevitably it’s managed to ruffle the BMA’s feathers) but powerful: why are you getting rid of us when there’s so much left to do?

And they have a point. For all the criticism that may be levelled at it – not least its increased reliance on data that risks an Ofsted-esque fallacy when the Annual Health Check’s assessment is based largely on compliance with standards, targets and initiatives set by the government – the Healthcare Commission does command a level of respect that other regulators (such as Ofsted) could only dream of.
Most importantly, its Chairman, Sir Ian Kennedy, and its CEO, Anna Walker, are the organisation’s biggest critics. In a remarkably candid open letter published recently in the HSJ, major regrets are outlined for all to see – and are inherently sensible:
1. That ‘inspection’ should reflect outcomes – the safety and quality of care, the outcomes of care and the experiences of patients – not processes.
2. That audit should be real-time, not post-hoc.
3. That the focus should be on individual units and pathways, not just organisations.
These themes are translated into today’s report.
Take silos targeted by the government and you get a good picture. The NHS has more resources and staff than ever before, it is busier than ever before, waiting times have fallen dramatically, rates of premature death relating to cancer and heart disease are falling, MRSA and C-difficile are on a downward trend and year-on-year improvements on core standards and national targets. All good.
But look more broadly and a different picture emerges. ‘Cinderella’ services – maternity, children, learning difficulties, mental health – remain on their way to the ball, stumbling along the way; and, focusing on the individual patient and their experiences across their pathway of care shows up big problems. Targeting silos with little attention to broader quality metrics has led to a discerning lack of integration, lack of flexibility and lack of focus on patient concerns.
Over to the Care Quality Commission.