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More policing of trusts will not improve standards


Last week saw the Underwater Rugby World Championships. No British teams were taking part, mainly because nobody in Britain plays underwater rugby - at least not on purpose. One or two people quite like the idea of it but they are either drunk or otters. Anyway, we were not missed.

Underwater rugby is quite big in the rest of Europe. It isn’t just a game played on the beach by people without a lilo. It is a sport and has an association with rules, membership and something akin to a regulatory body. If you want to join you need to pass an assessment. I’m thinking trunks, a snorkel and too much spare time ought to swing it. But if you fail
you have to play something else like underwater frisbee or imaginary skittles.

I am always surprised at how quickly people form associations, committees or commissions these days. It seems that as soon as three people take an interest in something they build a website, get some letterheads and call themselves an organisation. You’re nothing if you are not audited, regulated and administered.

‘Isn’t there something wholly self defeating about stripping people of responsibility for standards and transferring that to outside policing agencies?’

The fallout around the “failing hospitals” raises many issues, some of which concern the organisations charged with assessing hospital standards. No doubt it will raise questions about so called “tick box” assessments and increase demands for verifiable inspections, a more detailed process of policing and stricter rules around measuring quality. But I wonder if that will that make it all OK?

One would like to think that there are already enough organisations that measure quality, apply regulations and check the people who measure quality and apply regulations to ensure that hospitals are policed. So what next?

I suppose it is logical that when we find a systemic failure we, first, want someone to blame and, second, want safeguards in place to stop it happening again. But leaving aside the fact that a culture of blame brings out the worst in everyone, do we really need to respond to every “failing” with a demand for greater or tighter regulation? Might it not be the case that greater regulation and more bureaucracy is actually making things worse?

Isn’t it remotely possible that in investing in processes that police and inspect we are actually reducing the autonomy and effectiveness of staff? Staff who, because of the constant processes of assessment, address inspectors rather than standards? Isn’t there something wholly self defeating about stripping people, teams and organisations of moral and clinical responsibility for standards and transferring that responsibility to an ever expanding plethora of outside policing agencies?

We may have problems of inspection or ratings but we are creating a culture that looks at passing tests rather than establishing best practice and, whenever that process is exposed, we create a new layer of bureaucracy rather than address a culture of disengagement. Is that really the best we can do? Personally, I am unconvinced.


Readers' comments (3)

  • A simple patient exit questionnaire would be far more effective and; just as important in today's financial climate, would provide a monitoring system much less expensive to operate.

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  • Charlotte Peters Rock

    No Inspection Agency, whose staff is made up from people who have worked for the Trusts which that Agency oversees, is likely to oversee adequately. The 'close colleague' system ensures that where complaints are made, the Inspection Agency will always side with colleagues not complainants, no matter what the provable facts are.

    A further serious problem is caused by the fact that all Trusts are run by legal teams, not by the Board of Directors. Those legal teams and Directors will deliberately flout the Data Protection Act and the Access to Health Records Act, in order to hide evidence.

    This means that all so-called 'professional' staff are gagged, and not allowed to act as responsible professionals. For as long as this destructive and secretive regime continues within NHS Trusts, patients are not safe, and professionals will not accept responsibility for their own actions.

    Many 'whistleblowers' know this to their cost.

    Many patients, having made a formal complaint, following unnecessary injury or - by grieving relatives - after death, are fully aware that over many years, they will be called liars by legal teams, who are highly paid by NHS Trusts. They will be deliberately run out of money, by lawyers, who no matter what the truth, will not allow any decent end to their suffering.

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  • Yes Charolette, I agree with every word in your comment. It is impossible to describe the degree of deceit and corruption that I have witnessed in senior managers and their legal teams. To make matters worse Human Resource advisors and many union representatives collude in this corruption.
    I have on 2 occasions addressed serious concerns in service provision. The intimidation from top management was shocking, and acted as a powerful deterrent to any colleagues who thought about raising valid concerns. No patient or employee is safe in this culture of fear.
    Kathleen White Edinburgh

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