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When is good not really good?

26 Feb 2015 - 2 Comments

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Yesterday the Care Quality Commission published its inspection report into Southern Health NHS Foundation Trust. Those of you who are regulars here will know this is a Trust I have a particular interest in via the JusticeforLB campaign. LB, Laughing Boy, died a preventable death in their ‘care’ in July 2013 and we’ve yet to see any real improvements. The unit where LB was has been shut since a horrendous CQC inspection a couple months after (yes after) he died – so even after a patient had died a preventable death, it still took the regulator to issue enforcement notices, before any action was taken. Luckily for many others in Oxfordshire that action involved closing the service. Back to the present day, sneeking up to two years since LB died, over a year since the independent Verita report found his death was preventable, the Trust volunteered to be one of the first inspected under the new CQC inspection regime.

One interpretation of that is that they’re forward thinking, honest and transparent and seeking feedback. Another is that they were keen to go first when the model was new, inspectors were more likely to play it safe and there weren’t many comparators available. I digress.

The CQC issued 17 documents as a result of that inspection, I confess I’ve not read them all (yet). What is clear from the overall summary though is that the Trust’s services require improvement:

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It’s plain to see there, three out of five domains require improvements to be made. It’s great to see that staff are caring and responsive, but when services aren’t safe, effective or well-led it’s hard to see how that’s acceptable.

It’s a bit like a lovely restaurant, with top notch waiting staff who really care, top up your drinks without asking, genuinely respond to your conversation, bring you information and take your order….only for your food to come out a bit late, a bit cold and it becomes apparent that the head chef wasn’t on top of his game and your food is rubbish. You go home (if you’re lucky), develop food poisoning, complain and get told that the head chef has a string of restaurants to run, you can’t expect him to be aware of your meal, and if you keep complaining you’ll ruin it for other people. The next day you see the chef spurting nonsense on social media about how good his waiting staff, or his ingredients are, completely oblivious to the fact that it’s clear that what he is providing requires improvement.

Here’s another example, I had root canal treatment this morning (true story, the rest isn’t). The receptionist was pleasant and smiley when I arrived, the dental nurse was attentive and all over her suction game, but imagine if the dentist made a mistake and bodged my tooth up. I’m left in pain and ultimately my tooth falls out – but when I complain the dentist claims that it didn’t matter because the other bits of the service were good, it didn’t matter that the dentistry wasn’t safe and I’m now left with a big gap. It’s alright, about two thirds of our dentistry is ok.

This is how the Chief Exec of Southern Health has responded to the CQC report. Despite them having the documents in advance, and the opportunity to fact check, participating in a quality summit and no doubt many hours to read all of these reports – she responds by celebrating the good bits (fair enough) but seemingly not caring about the bits that require improvement. In fact they shared the news of the CQC inspection with the headline ‘CQC report highlights good practice within Southern Health‘, something that Sara brilliantly described as Blistering billy bullshite.

Perhaps it’s not clear enough, maybe the CQC are giving mixed messages, it’s a new inspection regime after all. In search of some more answers I dug a little deeper and checked out the CQC ‘How CQC regulates NHS acute hospitals Provider Handbook‘ published in September 2014. This handbook is completely explicit about how inspections happen and how judgements and ratings are made. It explains how every service is rated and where the aggregate ratings come from:

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Once services are rated, it explains how these ratings are used so that the Trust as a whole is rated:

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There is even a brilliantly explicit flowchart for those who still can’t grasp it (KLOEs are key lines of enquiry – what was looked at):

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Just in case there is any doubt about aggregate ratings the guidance is also explicit that ‘Our ratings must be proportionate to all of the available evidence and the specific facts and circumstances’. So these ratings are evidence-informed, they have already been fact checked by the Trust under inspection before they’re published, and there is really no doubt that Southern Health requires improvement.

Staff were distressed by the actions of the Trust, one assumes the Chief Exec and the Board.

‘Staff and service users were concerned about how the trust was handling the situation as they felt the trust had not been as open and honest as it could have been. This was clearly causing distress and affecting staff morale and unrest with people using services and their families. They felt the trust had failed to communicate effectively and was acting outside of its own values’.

Wow, that’s clear, about as clear a statement as you can make….and yet the culture of spin at Southern Health prevails. A Trust too big, too arrogant, and too unaware of the need for humility and candour. They’ve 28 days to produce an action plan, they really are quite expert at those – producing them not acting on them, time will tell.

 

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