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Mid Staffs was 'off SHA radar'

Cynthia Bower has hit back at criticism that she could have done more to prevent problems at Mid Staffordshire foundation trust in her former role as chief executive of NHS West Midlands.

The hospital trust was found to be providing an “appalling” standard of emergency care to patients, in a Healthcare Commission report published last week.

Ms Bower led NHS West Midlands from 2006 to 2008, while the crisis at Mid Staffordshire unfolded.

She said she could have acted sooner if the Healthcare Commission had shared its data.

She told HSJ: “What I absolutely believe is if they’d have shared that information earlier on we could have worked together to look at what the issues were.

“Because the fact remains that by going in and doing the detailed investigation that frankly only the regulator can do, issues emerged that didn’t emerge through other things we were doing.”

Engagement problems

HSJ understands the Healthcare Commission feels that it has been difficult to engage strategic health authorities in its regulation work.

The commission feels it shared its information as early as possible after moving to a new risk assessment system late in 2007.

It is also felt at the commission that NHS West Midlands was “distracted” by debates over the robustness of Dr Foster Intelligence mortality data. But Ms Bower said the trust wasn’t even on her “radar”.

She said: “The regulator had a range of tools and when they sat in accident and emergency… they did something we didn’t have the capacity or remit to do.

“I think we should have been working together on that.

“Instead the first thing we knew about their concerns was when they launched their investigation.”

She pointed out that the trust had been inspected by the commission in 2007 and had “met all the standards”.

The SHA commissioned work by the University of Birmingham, visited the trust, studied case notes and carried out audits after it was alerted to the Dr Foster data.

Regulators aim to improve joint working

Health regulators are considering how to collaborate more effectively in light of the report on emergency care at Mid Staffordshire foundation trust.

The Healthcare Commission report and the death of Baby P in Haringey have prompted discussions on better joint working.

Council for Healthcare Regulatory Excellence chief executive Harry Cayton said: “Everyone has been shamed and shaken by these tragedies and people are really committed to working together.

“I have been talking to the Care Quality Commission about how we make sure bodies that regulate individuals and bodies that regulate systems communicate effectively with each other.

“That is a real challenge and it is an important issue.”

However, Mr Cayton said that responsibility should ultimately be with the trust and strategic health authority.

“Accountability and responsibility all the way through the system wasn’t happening in Mid Staffs. The regulators are the last resort in this.”

The report said NHS West Midlands had been “assured by what [Mid Staffordshire] told them” in relation to its high mortality rates.

CQC chief executive Cynthia Bower, who was formerly chief executive at the SHA, has told HSJ the Healthcare Commission could have shared its information on the trust with the SHA earlier (see above).

The Healthcare Commission and Monitor - which authorised Mid Staffordshire as a foundation trust from February last year - have improved their information sharing in response to the case.

Foundation Trust Network director Sue Slipman said: “The lesson to the regulators is they need to share information in the future.”

However, it must be “managed in a way that is reasonable”, with definitions of what would be shared and when the relevant organisations would be informed.

Ms Slipman said quality accounts would require boards to pay attention to measures of quality and input from, for example, patients and GPs.

Manchester Business School professor of health policy and management Keiran Walshe said reform aimed at reducing the “burden” of regulation was misguided.

“In a health service that is increasingly plural and less hierarchically controlled there is a growing need for good, effective regulatory scrutiny and oversight.

“If one thing comes out of it, it should be that we bin the term ‘burden of regulation’ and start talking about what makes effective regulation.”

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