Highly rated but unsafe hospitals spark calls for regulatory reform

3 Dec 09
MPs have called for urgent reforms to the health care regulation system after two highly rated NHS trusts were found to be failing to keep patients safe
By David Williams

3 December 2009

MPs have called for urgent reforms to the health care regulation system after two highly rated NHS trusts were found to be failing to keep patients safe.

The calls came as new data revealed above-average death rates and poor hygiene standards at a number of hospitals, some given high scores by regulators.

NHS regulator the Care Quality Commission published a damning report detailing squalid hygiene standards at Basildon & Thurrock University Hospitals NHS Foundation Trust.

This followed action by foundation trust watchdog Monitor to remove the chief executive of Colchester Hospital University NHS Foundation Trust after discovering failings including patient safety.

Liberal Democrat health spokesman Norman Lamb told Public Finance that the system as it stood was ‘disastrous’.

He said: ‘There are several national bodies with some responsibility for patient safety – the Care Quality Commission, Monitor, the National Patient Safety Agency, the NHS Litigation Authority, the Health and Safety Executive – it ends up with no-one responsible.’

It was ‘ridiculous’ that two separate bodies were intervening at the same time in Basildon and Colchester, he added. ‘It smacks of a degree of competition between two national regulators,’ he said. ‘There ought to be one national organisation responsible for patient safety, and it needs to be the CQC.’

However, he went on to describe the CQC, which oversees all health and social care services with the exception of finance and governance in foundation trusts, as a ‘monster’.

He added that foundation trusts were not proving to be the standard-bearers of good practice they were meant to be.

On November 29, health care data suppliers Dr Foster Intelligence published a list of 27 hospital trusts with ‘significantly high’ death rates in England. Basildon headed the table, but the top four were all foundation trusts.

Dr Richard Taylor, independent MP and prominent member of the Commons health select committee, said it did not make sense to divide responsibility for foundation trusts between Monitor and the CQC.

In a report on patient safety published in July, the health committee highlighted the ‘potential for confusion, and possibly conflict, regarding the respective roles of Monitor and the CQC’.

Taylor called for a debate in Parliament on patient safety and the regulation system. He identified the CQC’s reliance on self-assessment data as a ‘huge fault’, and also recommended stronger patient groups to hold trusts to account locally.

But Nigel Edwards, policy director at the NHS Confederation, which represents health trusts, said regulation was only a ‘backstop’. Responsibility lay first with clinicians, trust board members and commissioners.

He said good management in the NHS required balancing many factors, including quality, safety, efficiency, and finance. ‘There’s not a structure that allows you to make those trade-offs neatly,’ he said. ‘This may be a behavioural issue as much as it is a structural one.’

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