THE BLOG
21/06/2013 09:06 BST | Updated 21/08/2013 06:12 BST

The Care Quality Commission Cover Up Is Not the Biggest Cover Up of All in the NHS

The Care Quality Commission (the CQC) has now named its officials who are alleged to have been involved in a cover up of an internal report critical the CQC's monitoring of Furness General Hospital.

Health Secretary Jeremy Hunt has tweeted in response: "Pleased to receive CQC letter naming the individuals involved. Clear sign NHS is changing. We must have accountability throughout the system."

It is reported in The Daily Telegraph that Hunt will today say that the names of the doctor and nurse "ultimately responsible" for a patient should be placed above every hospital bed in Britain.

We detect an attempt to shift blame away from the NHS leadership and higher regulatory bodies, towards doctors and nurses struggling at the coal face often under impossible conditions. Searching through the biographies of senior managers of the Care Quality Commission, it is difficult it is to find many, if any at all, running the body in charge of checking standards of care, who had worked as a doctor or nurse in the NHS.

Jeremy Hunt may want the names of doctors and nurses 'ultimately responsible' for patients above every hospital bed, but why should the Chief Executives and members of Trust Boards not be there as well? Or the name of the inspector from the Care Quality Commission who last inspected the Trust?

Or should the list of people include the innumerable bureaucrats and administrators who make life and death decisions over allocation of funding and running of services, be included in those 'ultimately responsible'?

Maybe that is a fundamental problem with the NHS today - the sheer size of the bureaucracy and the widening distance between those who run it and the patients they are meant to be caring for.

A fundamental conflict that remains covered up in the NHS is the divide between what kind of health care doctors believe should be delivered to patients, and what administrators are prepared to do. Because doctors are employed by the NHS, the public may be confused into believing that the health care they receive at the hands of their doctors, is what the medical staff want to provide. Far too often it is not.

Now more information about the numbers and influence of doctors in the boards is available.

Gianluca Veronesi, Ian Kirkpatrick and Francesco Vallascas, of The University of Leeds, have recently published a study examining the number of doctors on the boards of Trusts in NHS England. They were prompted to conduct the study partly because the number of clinicians involved in the strategic governance of hospital trusts in the UK, is relatively low by international standards.

The study entitled 'Clinicians on the board: What difference does it make?' found that a higher percentage of clinicians on NHS Trust boards is associated with higher quality ratings of service providers, especially where doctors are concerned. Across England, an NHS Hospital Trust's position in the league table could be determined by how many doctors were on its board. Trusts in the bottom 25%, compared to those in top 25% in quality of care, had a 10% difference in the share of doctors on the board. Adding 10% more doctors meant you moved up the table dramatically.

The finding, published in the journal Social Science and Medicine, confirms only very limited progress has been made in recruiting clinicians onto the boards of NHS hospital trusts.

This is despite the fact impact of clinician board members in the NHS appears to be considerable. Even a small increase in the number of doctors on boards (10%) can have marked consequences for hospital outcomes, according to this study.

Notwithstanding the importance of nursing in the delivery of care services, this study found that the influence of nurse directors of NHS Trust performance was negligible, unlike the impact of having doctors on boards.

Amanda Goodall, Associate Fellow, University of Warwick, recently published a study looking at the top 100 U.S. hospitals in 2009, as identified by a widely-used media-generated ranking of quality, in three specialties: Cancer, Digestive Disorders, and Heart and Heart Surgery.

The personal histories of the 300 chief executive officers of these hospitals were then investigated and the CEOs were classified into physicians and non-physician managers. This study, also published in the academic journal Social Science and Medicine, confirms an extremely strong positive association between the ranked quality of a hospital, and whether the CEO is a physician or not.

The study entitled 'Physician-leaders and hospital performance: Is there an association?' concludes that US Hospitals positioned higher in quality league tables are much more likely to be led by medical experts rather than managers.

Not only NHS Trusts, but a large number, if not all, NHS and related institutions, including the Care Quality Commission, do not have enough clinicians driving key decisions.

We feel that the public should be aware of who really is issuing the prescriptions in the NHS.