David Oliver: Why shouldn’t hospitals challenge inspections?BMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h5320 (Published 06 October 2015) Cite this as: BMJ 2015;351:h5320
All rapid responses
A predictably high quality critique by a very knowledgeable clinician and ex-DH insider/adviser! It encapsulates the Kafkaesque outcome of a good idea, which after being submitted to committees, civil service and politicians, ended up with its commendable spirit having been drowned in the statutory letter.
In our profession's practice and also in its education, the past two decades or more have seen amazing advances in helping patients and learners both to understand their challenges more clearly and change their behaviours for the better through constructive, user-centred, formative feedback. Even revalidation, our statutory personal accreditation mechanism, is built (at least in theory) on a formative appraisal process, designed to help professional growth. We now head the Commonwealth Fund table for health care & have the best palliative care in the world, yet many of our trusts are struggling according to CQC reports. Most would agree with the Nuffield Trust that this is because of lack of resources: whether any or all of IT, staff or money. The latter problem already looks bigger half way through the financial year, than last year's total, as many predicted.
Why is it that the system which oversees all this frenetic clinical and educational activity - and which must have incredible experience - completely ignores the often painful learning in other areas about feedback that a generation of the profession has gone through? CQC inspectors are systematically precluded from giving advice!
I'm old enough to remember the Health (& subsequent Hospital) Advisory Service. Effectively, this was peer review of mental and then geriatric services by experienced clinicians, for their colleagues. Denmark have recently eschewed inspection in favour of professional peer review.
Why don't we follow suit - learn from peers and prevent as we go, rather than damn and attempt to rescue post hoc. Prevention is, after all, what the Tory party manifesto proclaims for both primary care and cancer - why not for the NHS itself, too? Surely the senior clinicians and politicians at the centre of this damaging system can see that changes towards collaboration, continuity and clinical leadership within and by the profession apply equally cogently to the system itself, rather than the current confrontation, criticism and discouragement - which can result in patient harm? If Scotland can do it, why can't England?
1. http://www.gmc-uk.org/doctors/revalidation/9627.asp [accessed 6 Oct 2015]
2. http://www.commonwealthfund.org/publications/fund-reports/2014/jun/mirro... [accessed 6 Oct 2015]
3. http://www.bbc.co.uk/news/health-34415362 [accessed 6 Oct 2015]
4. http://www.bbc.co.uk/news/health-31849833 [accessed 6 Oct 2015]
5. https://fullfact.org/factcheck/health/nhs_deficit_hospitals_red-47520 [accessed 6 Oct 2015]
6. http://navigator.health.org.uk/content/health-advisory-service-and-hospi... [accessed 6 Oct 2015]
7. http://gpaccess.uk/news/hospital-accreditation-to-end-in-denmark/ [accessed 6 Oct 2015]
8. The Conservative Party Manifesto 2015 http://ge15.demsoc.org/wp-content/uploads/2015/03/Conservative.pdf (p39) [accessed 6 Oct 2015]
9. http://www.dailymail.co.uk/news/article-3195669/Elderly-left-freezing-cr... [accessed 6 Oct 2015]
10. http://www.jitscotland.org.uk/about-jit/background/ [accessed 6 Oct 2015]
Competing interests: the trust in which I work was put into special measures last year. We are currently awaiting our re-inspection outcome. This response is written in a personal capacity