The shocking callousness at the top of the NHS

For the CQC leaders, the patients seemed to have been an irrelevance. The system had to survive

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The Independent Online
  • On 2 December 2014, the Care Quality Commission settled proceedings brought against it by Jill Finney, its former Deputy Chief Executive. The proceedings arose from the publication of a report into CQC’s regulation of the University Hospital Morecambe Bay NHS Foundation produced by Grant Thornton, which was highly critical of Ms Finney. In settling the action, the CQC accepted that its handling of the report and its publication disadvantaged Ms Finney’s ability to protect her reputation and publicly defend herself against an allegation (that she was involved in a cover-up) which she had always denied. The CQC offered an apology to Ms Finney and repeated an earlier statement by its chief executive that Ms Finney had been a “rock of stability in the CQC”. The CQC paid damages of £60,000 to Ms Finney as well as costs in excess of half a million pounds.

I fear the NHS, one of our nation’s most virtuous and precious creations, is speeding towards annihilation.

Post-war courage, big political dreams and remarkable human endeavour shaped and created the service. Cowardice, meanness, lack of humanity and vision may well cause its total disintegration. Ever since the days of Thatcherism, fanatical privateers and profiteers and their political allies have been flapping their predator wings, waiting to fly in an American-style system where money buys good health and those without suffer avoidable diseases and deaths. These vultures must be cheered to witness the latest in a line of NHS scandals. Another catastrophic failure has burst into the media and public consciousness, another self-inflicted wound which bleeds the confidence of doctors, nurses and patients.

This time it is the Care Quality Commission (CQC), an over-centralised body set up by New Labour in 2008 to monitor service delivery and good practice in all healthcare trusts. Its job was to inspect 22,000 health and social care providers – including hospitals, GP and dental surgeries and care homes. It seems plain to me that too much was asked of one body but few seemed to have objected at the time. Why would they when there were such well-paid and venerated positions available for the “great and good” who sit on such commissions, a thriving sector for a small, select circle? It has now been alleged that three of those at the top of the organisation acted little better than those bankers who played fast and loose with investments, did not value the importance of accountability and, if the allegations are proved, didn’t seem to give a damn about their customers or the entire profession which they brought into grave disrepute. Sure, those at the top of the CQC loved the NHS, but they also seemingly loved themselves, their cliques and power much more. The CQC named three women who are currently facing disciplinary action, Cynthia Bower, Dame Jo Williams and Jill Finney, although all deny any wrongdoing. Remind me of that the next time I eulogise about my sensitive, compassionate gender.

Last week the independent Grant Thornton report revealed the way they believe that these leaderenes had deleted a previous report which severely criticised the CQC’s investigations into the Morecambe Bay NHS Foundation Trust which managed hospitals with the highest mortality rates in this country for newborn babies and mothers. The three dispute the Grant Thornton view. In 2012, Kay Sheldon, a non-executive director at the CQC, bravely spoke out, told Andrew Lansley, then Health Secretary and others in power that the commission was failing in its duties. She told Independent journalist Nina Lakhani how she then became a marked woman. In the style of the old Soviet Union, Williams is alleged to have commissioned a covert assessment of Sheldon’s mental health. Without meeting her, the obliging doctor suggested Sheldon, who suffered from bouts of depression, was possibly a “paranoid schizophrenic”. Dame Jo Williams had been previously chief executive of the disability charity Mencap. It all beggars belief.

Meanwhile the survivors – dads who had lost their partners and babies, mums grieving for their tiny infants – were not listened to by the hospitals. Some midwives and others on staff colluded to hide evidence of malpractice. It gets worse. Carl Hendrickson was a low-paid cleaner at Furness hospital, where his wife Nittya and baby son Chester died in 2008 during birth. He was visited at home by the Trust chief executive Tony Halsall who allegedly offered  him £3000: ‘“We’ll find you a job in Preston. You can move from this area and we can all move on with our lives”. There are many such appalling stories. For the CQC, which should have dealt with such callousness, patients seemed to have been an irrelevance. The system had to survive.

Obviously no health service can guarantee no mistakes, no accidents. But there can and must be better safety rules and systems and behavioural conformity to tested guidelines. As vital is team work and a culture of respect between colleagues and for patients. The CQC failed on all these essentials and was not fit for purpose.

Next Thursday at a conference on patient safety organised by Imperial College and the Imperial Health Care Trust, I am interviewing Martin Bromiley, a pilot whose wife died in 2005 in hospital after a routine sinus operation, the result of human error and dysfunctional hierarchical norms. Two nurses could have intervened to save her life, but didn’t feel able to. That bereavement made him into a driven and highly respected advocate for a safer NHS, as safe as flying. The chances of a passenger dying in an airplane accident is one in ten million; in our hospitals it is one in three hundred. The speakers and attendees feel as passionately as Bromiley that things can and must get better.

Like the majority of British citizens I believe NHS frontline staff and managers who maintain this complex structure, on the whole, do a brilliant job. Successive governments have made it harder and harder for them to function and hang on to ideals, yet most have carried on with integrity. They must now fear that the end of our beloved NHS will be hastened less by external forces, more by committed insiders. How shall we grieve and mark its passing? How will we forgive ourselves for letting this happen to an institution that cared for most of us from cradle to grave, or promised to?