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Exclusive: Lansley on the CQC, integration the reform risk register and commissioning


Andrew Lansley has told Nursing Times’ sister journal, HSJ, the Care Quality Commission is now running a “proactive and tough” inspection regime and revealed he does not favour further reorganisation of NHS regulation.

In an exclusive interview, the health secretary also said he favoured the creation of “accountable care organisations” to drive integration, was close to giving “reassurance” on education and training policy and reiterated his support for small clinical commissioning groups.

Mr Lansley said he had told the CQC to “be proactive and tough in terms of shining a light into areas of poor performance and rooting them out”, and to carry out more inspections.

He said: “People would recognise over the course of this year [that they] have been doing exactly that. Across the NHS there’s an appreciation the CQC is now not just arriving in order to tick boxes on whether you’ve got policies in place.”

He said the Department of Health review of the regulator, reported previously in HSJ, was the first instance of a process which would also be carried out for other health bodies. It was “not about” ministers’ confidence in the current CQC leadership.

The Mid Staffordshire Foundation Trust public inquiry, whose terms of reference include the regulatory system, will report next year.

But Mr Lansley said: “In addition [to previously asking it to carry out more inspections], I have no plans for changes to the CQC.”

He said that at Mid Staffordshire, “lots of people had formal responsibilities but nobody seemed to have delivered on them”.

“We will see what [inquiry chair] Robert Francis has to say but I don’t think it’s about whether there are people who have a responsibility for ensuring high standards, it’s actually about making sure the culture in the NHS achieves that.”

In relation to his current reforms, Mr Lansley said he thought the DH needed to encourage integrated services – something highlighted by the NHS Future Forum after the Health Bill was put on hold in the spring.

He said: “Commissioners clearly can support it [and] we can support it through things like tariffs based on care pathways and bundles.”

Mr Lansley said there were also “things we can do organisationally”. He advocated the model of accountable care organisations, most commonly, although not exclusively, associated with the US healthcare sector. These are networks of providers which are given a pooled budget for patients’ care and are monitored on their performance and quality.

Mr Lansley said accountable care organisations could be beneficial “in so far as they bring hospital and community services together, in order to create an organisational form that is more integrated”.

But he added: “They have to do it in a way that doesn’t create monopolistic services that don’t offer patients choice.”

He said he planned to “give further reassurance” about education and training policy, in response to the current Future Forum review. This could involve further changes to the Health Bill.

Responding for the first time to the Information Commissioner’s judgement that the DH should publish its “register” setting out the risks of the reforms, he said the DH had yet to decide whether to appeal the decision.

But he said: “There’s a great danger if it’s published… it will tend to mislead. It will give an impression… there was an expectation [that all the risks would be realised]. The purpose [of the document] is to get open, honest internal reporting so all necessary mitigating actions can be taken.”

Speaking about the award of a management franchise to run Hinchingbrooke Health Care Trust to the independent provider Circle, Mr Lansley did not rule out a similar approach elsewhere in the future.

He said: “It wasn’t a quick process so to that extent clearly we wouldn’t replicate it in that form. I don’t at the moment have any plans for that specific approach elsewhere… That doesn’t mean we exclude it.”

* CQC chief executive Cynthia Bower told HSJ the DH had approved its recruitment of a further 230 inspectors for 2012-13 – an increase of nearly a third on present numbers. She also said the CQC was increasing the number of unannounced inspections each month.

Lansley: Smaller CCGs will be affordable

The health secretary said the administrative allowance for clinical commissioning groups would be large enough for small groups to operate.

Mr Lansley would not confirm the size of the allowance which is expected to be published in coming weeks. However, he sought to calm some CCGs’ fears that it will be too low to allow CCGs with fewer than 200,000 patients to be authorised. Some fear it will be as little as £20 per head.

He said: “The NHS is obsessed with size and organisational uniformity. In truth leadership matters more.”

Talking about competition rules, Mr Lansley said the current requirement for primary care trusts to carry out any qualified procurements by next year was in place because “if we don’t it won’t happen because that’s the nature of the system we’re in at the moment”. But he said: “In the future CCGs… will not have a formal requirement to undertake specific elements of choice.”

Mr Lansley said PCTs had already delegated £28.9bn to emerging CCGs, from a total of £62.3bn eligible to be taken on.



Readers' comments (4)

  • tinkerbell

    HELP! I have just received this reply from my MP.
    Does anybody understand what this all means? Somewhere in this reply the meaning got lost in the words for me (this is probably deliberate) but even so could someone pick the bones out of this and tell me what it all means in good old fashioned, crystal clear, plain english. Which part of it doesn't make any sense to me? Answer, any of it. If it doesn't make any sense then it is probably not true and it is a deliberate attempt to confuse us all with a superfluous use of words.

    Thank you for your email regarding the ‘risk register’.

    Having contacted the Government with regards to this issue, the Department of Health have issued the following statement:

    “It is important to understand that the risk register sets out all of the potential risks identified by the Department of Health for the entire range of areas for which it is responsible. These include financial risks, policy risks and sensitive commercial and contractual risks. It is a means by which the Department focuses on risks and acts to mitigate them.

    “Although we do recognise the public interest in this information, we need to understand whether the public interest is best served by releasing this information, insofar as it could misrepresent the end result whether impacted or not by the mitigating action. That is why the Department of Health is currently considering its response to the Information Commissioner’s decision, and will respond to the decision in early December.

    “The risk register is intended to form part of an internal focus on action to minimise risks. Such risks are reflected in public statements, in a balanced and evidence-based format, through the publication of impact assessments. In relation to the Government’s health reforms, I should like to assure you that the Government has been open and transparent about the results they will deliver, through the impact assessments published and updated as recently as September. These assessments, which include an assessment of the benefits and risks of the Government’s health reforms, are available on the Department of Health’s website, here:”

    I do not feel wholly satisfied with this response therefore I have written to Andrew Lansley and asked him to release immediately the parts of the ‘risk register’ that do not relate to sensitive commercial and contractual risks.

    Thank you again for contacting me.




    Of course Gordon doesn't feel 'wholly satisfied' with this response because it doesn't make any sense and is a clear as mud. Open and transparent my a***(the party of the third part etc., where's the insanity clause?).

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  • Lansley in a hot air balloon realized he was lost. He reduced altitude and spotted a woman  below. He descended a bit more and shouted, "Excuse me, can you help me? I promised  a friend I would meet him an hour ago, but I don't know where I am." The woman below replied, "You're in a hot air balloon hovering approximately 30 feet above  the ground. You're between 40 and 41 degrees north latitude and between 59 and 60  degrees west longitude."
    "You must be an engineer," said the balloonist.
    "I am," replied the woman, "How did you know?" "Well," answered Lansley, "everything you told me is, technically correct, but I've no  idea what to make of your information, and the fact is I'm still lost. Frankly, you've not  been much help at all. If anything, you've delayed my trip."

    The woman below responded, "You must be a Tory MP." "I am," replied Lansley , "but how did you know?" "Well," said the woman, "you don't know where you are or where you're going. You have  risen to where you are due to a large quantity of hot air. You made a promise, which  you've no idea how to keep, and you expect people beneath you to solve your problems. The fact is you are in exactly the same position you were in before we met, but now, somehow, it's my fault."

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  • tinkerbell

    Anonymous | 16-Nov-2011 3:26 pm

    well done, think you've answered my question. Thanks.

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  • I was going to write about the nonsense that management make of CQC, tying themselves in knots gathering 'evidence' that is so patently inadequate but the more I read of what Andrew Lansley has to say the more despair I feel at how the NHS has fallen into the hands of someone with so much 'hot air'. Whatever will become of us?

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