It’s rare I revisit a topic twice in succession.
The NHS is rich with stories, things to praise, prise and pull-apart. It’s not often there’s a circumstance when I want to hammer the nails in, again.
But…
… today I’m going to because, the whole issue of regulation has ignited such a response that if emails were letters, I’d have to weigh them.
There are more than 90 regulatory bodies in the UK, with total expenditure in excess of £4 billion a year.
They cover education, healthcare and charities to transport, communications, the media, utilities and the environment.
Nothing works.
Our rivers are filthy, our electricity costs too much. Trains are always on strike. Nearly 94% of crimes go unsolved. Education regulators worry teachers to death… I could go on.
In the NHS there’s a huge and really quite aggressive dissatisfaction with the current tin-eared, regulators.
No appetite for more. Not because people want to cover up bad things. It’s because regulation, layers of it, has failed to reveal anything…
… failed the public, failed the people who pay for it and failed a complex organisation with built in fault-lines and fissures that get plastered over for fear of ‘regulators’.
It’s easy to dig up the past, so let’s turn our attention to the future.
It’s often said; the biggest worry for Trust bosses is workforce. That is not true…
... the biggest worry is financial balance. That’s where the bullying and real pressures begin and end.
Think about a Board at some point in the future, with regulated management, each with a ‘license to practice’, like doctors.
It’s not hard to imagine a situation; systems and Trusts struggling with demand, heading for financial deficits. Political pressure on waiting lists.
System managers exerting pressures but the numbers just don’t add up.
Boards and bosses could arrive at the point where they could no longer operate within their license… knowing that quality and safety was being prejudiced.
If they said; ‘we can’t do this, it’s not safe’…
... who would they say it to?
NHSE? They’d probably reply; ‘get on with it’… because on their backs we’ll find the DH+ the Number 10 numpties.
This is not the future. It is happening now…
… how many Trust Nurse Directors and Medical Directors, both of whom are regulated by their professions, have agreed savings, or staffing plans, knowing full-well, wards will not be safe, staff will not be able to cope, not escalate problems, not practice safely.
How many of these regulated, clinical directors have raised a hand, never mind a red-flag?
I know of none. Regulation has changed nothing.
How many have gone along with decisions they know are risky because they have to keep going, providing care… on a wing and a prayer.
No one says anything because, depending on where you are in the hierarchy, you’ll be either ridiculed, sat on, ignored or fired.
Regulation doesn’t work now and it won’t work in the future.
Regulation does not make people speak up, it inhibits them.
It is only regulators who think regulation works. They have skin, status and mortgages in the game.
A week ago, last Monday I mused on what might be an alternative.
It seems to me all these ugly, dangerous issues happen not because no one knows about them. It’s because no one dare speak about them… for if they do, reputation preservation, oppressive regulation and cover-up… means circling the wagons.
Isn’t something simpler needed? I wrote;
- If two or more consultants raise a safety critical issue, management must be obliged to call in a consultant from an adjoining Trusts to have a look.
- Make recommendations and carry them through.
- Make the learning available to everyone.
On reflection, I’d ask myself three questions;
- Should consultants be the only conduit?
- Should an inquiry be conducted by a senior and experienced manager and a senior clinician from the appropriate discipline, as required
- No more than three people and a secretariat.
… and to underline we have learned something from the past, let’s call the process, Countess Committees.
Look at, look into and learn.
If our purpose is the pursuit of excellence with safety trumping all else…
… is this the kind of openness that will breathe oxygen into a system…
… that’s choking on the pursuit of blame and the safety of reputation strangles all else.
Could we do this?
News and Comment from Roy Lilley
Contact Roy – please use this e-address roy.lilley@nhsmanagers.net
Reproduced at thetrainingnet.com by kind permission of Roy Lilley.
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