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Is scrutiny of care poorer the further you are from London?

The fact that two out of five hospital leaders fear “regulatory bodies and wider governance systems” would not detect another failure on the scale of that at Mid Staffordshire Foundation Trust is worrying enough.

The further finding from HSJ’s latest survey of acute trust chief executives that this number rises to over 50 per cent when answers from those running organisations north of the Watford gap are analysed highlights an area of particular concern.

The disquiet does not seem to stem from individual organisations’ performance. While London chiefs are the most positive about maintaining quality, those elsewhere in the South appear gloomiest.

It is more likely the differing views mirror the perceived competency of those monitoring quality of care.

There is a well-established belief that, with many watchdogs based in London, those organisations furthest from the capital tend to receive the least attention. This is usually attributed to a mix of the difficulty of monitoring at a distance, a lack of confidence in regional structures and a conviction that regulators will tend to focus on problems at high-profile organisations.

The scepticism of leaders based north of the Home Counties may also be a comment on the management of the transition to the new system. Is the tighter “grip” which some claim is evident in the South and the capital reassuring chief executives about the ability to spot failure?

The findings challenge those creating the new regulatory and quality monitoring regime not only to create a system which elicits much greater confidence than at present, but also one in which geography does not impact the standard of scrutiny.

Readers' comments (3)

  • it might just be that people who dwell in the wastelands north of watford are dour and of a less optimistic predisposition than the rest of us...

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  • Normally sensible, but this time your leader is well wide of the mark.

    Who has a reputation for "grip" greater than David Nicholson? Who was in charge of the system when Mid Staffs was silently going belly up?

    Your leader might just as well have asked why it is that the perception of the prevailing reource levels in London are high enough to think that there will not be another Mid Staffs there (not the question you asked, I know, but how people interpret questions and then frame their replies are not necessarily what was envisaged when the question was asked).

    Everyone knows that London swallows a dosproportionate amount of resource compared to its population, maybe this had something to do with the answers.

    Final point: for FTs, are you really saying that Monitor's approach is different with London hospitals?

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  • It depends what you mean by 'worse' I guess - it certainly seems to hurt more!

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