Part 5 of Peter Nolan’s six-part series on the Mid Staffordshire Foundation Trust Public Inquiry reveals how there was much confusion concerning the roles and responsibilities of regulating agencies and professional bodies
On coming to power in 1997, New Labour declared that the NHS, as a socialist-inspired project, not only was safe in its hands but also would become one of the foremost healthcare providers in the world. Prime minister Tony Blair repeatedly emphasised that a Labour government was fully committed to improving the NHS.
He said his vision was to change the NHS from a monolithic, top-down organisation to one that was owned and managed locally. Breaking the stranglehold of the Department of Health, he believed, would liberate the energies and imagination of local people.
By investing in the NHS, Mr Blair aimed to increase efficiency, reduce waiting times, improve the quality of care and generally improve the health of the nation. Responsibility for monitoring progress in healthcare was to be transferred from political control to regulatory bodies. These bodies would be independent and free to inspect and advise as they saw fit.
“If what occurred at Mid Staffs Hospital is to be avoided in the future, regulatory agencies need to be much more self-assured, confident, resourced and independent than they currently are”
In his evidence to the Mid Staffordshire Foundation Trust Public Inquiry, former health minister Andy Burnham stated that new Labour’s approach to health was idealistic and based on the assumption that the reorganisations of the NHS would inevitably improve the quality of care. Policies in themselves achieve little, he said - it is those doing the job who bring about change.
The new emphasis on regulation spawned a myriad of immature organisations, a burgeoning bureaucracy, a preoccupation with business models and the diversion of substantial funds from frontline services. When Blair came to power, approximately five million people were employed in the NHS; at the end of his premiership, that number had soared to six million, with non-clinical staff outnumbering clinical personnel.
Between 2005-09, the period that the inquiry focused on, was one in which confusion abounded concerning the roles, responsibilities, inspection methodologies and reporting systems of the various agencies. The inquiry heard that during this period, the various regulatory organisations and professional bodies were largely unaware of each other’s roles regarding what inspections were taking place and what the final reports contained. Furthermore, there was no agreement over: what an inspection visit should consist of; who should be recruited to the regulatory bodies; what resources were required; how reports should be produced and what organisations should be informed of their existence. In 2009 the HCC published a damning report on the hospital, which stated that some departments were unsafe and not fit for purpose.
In May 2008 Baroness Young was appointed chair of the Care Quality Commission, which became an active regulator in 2009 following the dissolution of the HCC. On 4 July 2010 she informed the Mid Staffs inquiry that she often encountered political interference to keep bad news out of the media and when CQC reports were found to be unfavourable, she was “leant on” to alter or “tone down” her reports so that they were less critical of the NHS. “Political interference was rife,” she said and in December 2009, the day following the leak of a damning CQC inspection report to the media into poor standards of care at Basildon and Thurrock University Hospital Foundation Trust, she resigned. So disenchanted had she become, she told the Inquiry that she “would never work for a government department again, especially the NHS”.
If regulation is to play a part in service improvement, collaboration between regulators is not only desirable but essential. Furthermore, regulators must themselves be regulated and quality assured if they are to act as role models to providers for how inspections should be carried out. They should base their judgements on much better evidence than on self-reporting, the meeting of targets and the unquestionable acceptance of what they are told. They should assist all health and social care providers in improving their services, not merely intervening when things go wrong.
If what occurred at Mid Staffs Hospital is to be avoided in the future, regulatory agencies need to be much more self-assured, confident, resourced and independent than they currently are.
Peter Nolan is professor of mental health nursing (emeritus)