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4/5 hospitals need to improve. And the other one?

Couple of mornings ago I was just enjoying my porridge when the Today programme told me that four out of five hospitals need to improve!  Spluttering, I had to leave the porridge to cool while I took to Twitter.

No, it’s not the four I’m worried about, but the other one which presumably thinks it doesn’t need to improve.  All of us need to improve – companies large and small, hospitals, GPs, parish councils and governments.  A minute later Radio 4 was telling us that 2/3 police forces were performing well while 1/3 weren’t.  Utter nonsense.

The real scandal is not the hospitals, or the police forces, but the thinking which labels performance as binary good/bad, pass/fail, and it’s this system of rating which infects government from top to bottom.  People moan about CQC for its charges, its bureaucracy and bother, but the heart of the evil it spreads is the way that it rates its victims.

Measurement is crucial to improvement, but it matters what you measure and how.  The best place to start is with what matters most to patients, and if you don’t know, think about the last time you wanted help from your GP.  Yes, it’s how fast you can get help.  Not the only thing that matters by any means, but you’d have thought that at least the multi £million CQC would have realised.

Recently we’ve produced datasets for two practices, one labelled by CQC as “good” and the other “inadequate”.  It’s clear from the former that patients are being turned away almost all day from 8.45, and are struggling to make appointments.  The latter, while ticked off for records on staff checks and vaccines, has a policy of never turning patients away, and it’s clear from their data that they don’t, accepting calls right up to closing time.

Do you want a tick box culture in general practice, or one with a passion for patient service at its heart?  I know what I want, and if the government wants it then nothing short of a total rethink of CQC will get there.

Harry Longman

4 responses to “4/5 hospitals need to improve. And the other one?”

  1. I was unsure what the Clinical Quality Commission’s mission statement was. So I looked on their website. The first line is: “Making sure services meet fundamental standards that people have a right to expect whenever they receive care.” Your review of the two practices is helpful if CQC standards are revealed. I am more confused. Does your data indicate that the CQC standard for primary care is NOT to be available after 8:45 AM to see patients on the same day they seek care? Is the CQC standard irrelevant to seeing patients? Does it mean it is better do something other than being available to see patients and perform eyewash to score well for bean-counters recording CQC standards?

    • Harry Longman says:

      I think the closest suggestion is that CQC standards are irrelevant to seeing patients, or to be more precise, they have no way of measuring access for patients. We’ve shown that it is not only possible, easy to measure on an industrial scale, so there’s no excuse!

  2. Umesh Prabhu says:

    Well said Harry. In my hospital we have reduced harm to patients by 90% and CQC rated us as good. I am pleased with this rate, CQC did identify 3 areas which needed improvement. You are right all Trust and GP practice needs improvement. Personally I feel CQC has come a long way but it also needs to improve. When you have so many staff working for you there is always room for improvement and as human beings none of us are perfect and we all can be better. Now look at snowy white peak in NHS and 45% doctors are Black and Minority ethnic and hardly any good senior BME leaders in the top on NHS and this has to improve as well. We have reduced harm by 90% by tackling inclusion and diversity by appointing value based leaders and good governance. Until this is done across the NHS, I doubt if NHS will be safer better. We all got to improve.

  3. dr v. p. parmar says:

    this beurocracey which is totally un necessary is causing un nessary expenses and paper work.
    not surprised many practices are closing and difficult to recrute gp in gen practice.
    the question is who will change this mind less task put on us.

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