CROYDON COMMENTARY: Are we, as patients, safe in the hands of the NHS? DAVID CALLAM welcomes moves for more stringent, and transparent, scrutiny 

Is Croydon’s Mayday Hospital a completely safe place in which to be treated? Or is it badly managed and dangerously short of nursing staff?

My own experience as an in-patient on three occasions in the past five years has been entirely satisfactory; indeed, I am a supporter of the hospital’s hard-working medical and nursing staff.

The ancillary staff work hard too, but I remain to be convinced that we need the hordes of highly paid health service managers who seem to infest offices at borough, sub-regional and regional level, as well as nationally. What do they do?

Despite all these reams of paper-pushers, I cannot find an independent view of the hospital’s performance that I can quote with any confidence, because successive governments have set up and presided over a sloppy system of oversight.

Until recently the Care Quality Commission ran an inspection regime that didn’t involve very much inspection. The commission was apparently prepared to shred any report that suggested an establishment was less than well run.

Every time we hear about a failing hospital, we also hear that the CQC has recently given it a clean bill of health. That would be funny, like an episode from Carry On Doctor, if it wasn’t so serious.

In truth, these hospitals have been left to inspect themselves. And self-praise is no recommendation, particularly when it is part of a mindset in which potential whistle-blowers are gagged with bribes or the threat of legal action.

The CQC, under new management, is finally in the process of appointing suitably qualified inspectors who will visit hospitals, care homes, dental and GP practices. But what level of confidence does the commission still inspire, if any, and what rigour of inspection will it be allowed to introduce?

In the early years of my working life I spent a period in the internal audit team of a government department. The work was mind-numbingly tedious, but it was dutifully done by a team (myself excepted) who were experts in their respective fields. We arrived, unannounced, on a Monday morning at a district office somewhere in the south of England. Our team leader requisitioned suitable workspace and presented the office staff with a list of required files.

Woe betide any manager who was less than fully co-operative.

Primarily we were looking for fraud in a department whose transactions were mostly done in cash, but we also checked to see that best practice was followed in all other matters relating to income and expenditure.

As a junior member of the team I was allowed to leave at lunchtime on Friday, partly because my boss and his senior officers would spend the afternoon asking questions – sometimes awkward questions – of the office manager.

Any office deemed to be sloppily run would be marked down for frequent inspection. I remember one particular office that was inspected every three months for a year, after which the manager was moved to a job at regional office under the watchful eye of his seniors.

In my naivety I assumed that all public service inspections were similarly exacting and certainly that third-party contractors would be regularly and carefully monitored throughout the period of the contract.

Privatisation is a term bandied about by opponents of NHS reorganisation. They wave it like a shroud, threatening the end of medical practice as we know it in an attempt to frighten patients and their relatives, and thus bring political pressure to bear on the government.

In reality, reorganisation will bring a variety of private-sector providers into the NHS to join existing public sector ones. The change is long overdue. It will allow us to make a wonderful but outdated creation of the 1940s fit for the 21st century.

In the past 65 years the National Health Service has never become truly national. Everything from drugs to laundry to catering and cleaning is organised locally, or regionally, allowing suppliers to charge higher prices than they could if a UK-wide health service had the buying power of an Asda or a Tesco.

It is quaint to see doctors struggling to find what they want in bulging paper files, but it is an admission of failure that the NHS hasn’t consigned all this data to a comprehensive computer network.

It’s dangerous, too. A doctor in Croydon’s A&E, treating a possibly unconscious or otherwise uncommunicative patient, has no access to his or her case notes; no indication of what might be wrong or what mediation the patient is already taking.

There are plenty of examples internationally of health services where the public and private sectors work together – France, Germany, Holland and the Scandinavian countries come immediately to mind. Denmark has a 90 per cent approval rating for its health service, compared with just 60 per cent here.

But any system of healthcare will only succeed if users have faith in it. And that will only happen if the contracts – public and private alike – are tightly drawn in favour of the patients’ interests, and are subject to unnotified expert inspections.

And it must be a condition of every contract that concerned employees are allowed to express their views freely.

In an establishment as complex as a hospital I would expect to see detailed reports about individual departments – some may be brilliant, others may not.

It is government’s job:

• to set clear national policy – no more postcode lottery of money being allocated differently for essential procedures from trust to trust;
• to support the policy with a properly funded, rigorous inspection regime;
• to ensure that a culture of openness is embedded in the NHS.

If the sloppy practices of the CQC are allowed to continue there will be increased distrust, not to mention more unnecessary deaths.

Personally I would like to see the management of the NHS wrested from the greasy grasp of politicians; the unseemly slanging match in the House of Commons on Tuesday is precisely the wrong approach.

But I don’t think either major party will readily relinquish what they see as such an important political prize.

Previous commentaries by David Callam:

• Purley’s £11m hospital scheme sweeps value under the carpet
• £1.5bn Hammersfield scheme hits a planning road block
• Cultivating culture is year-round project, not just three weeks
• Busy Boris means business with £5.7m streets scheme

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Related articles

• NHS care watchdog CQC to overhaul hospital inspection system (guardian.co.uk)
• Hospital inspections ‘to be tougher’ (bbc.co.uk)
• Army of patients to be recruited to inspect NHS (telegraph.co.uk)