Michael White: shamed FTs, Dr Foster, cancer care

In both instances what is going on here is the drive towards higher performance via the process of transparency. It is painful and it is far from infallible. MPs know that to their own cost: think expenses.

The Daily Beast has uncovered hanky-panky on the wards

They hated it too, not least because a lot of the criticism was unfair. Mistakes are also made by health regulators and professional analysts, just as they are by providers. It is part of what Marxists might call a dialectical process.

It is not cost free, of course. Public confidence, already as neurotic and often ill-informed about real health risks as property investors in Dubai, is further undermined by a stream of disclosures. They are wrenched from context and exaggerated by a media famous for its own lack of accountability and openness.

In the row between Dr Foster and the Care Quality Commission, self-assessment is surely an Achilles heel, a form of tick-boxing. That happens in Fleet Street too.

I was reminded of this after listening to Philip “Mr Dartboard” Hammond, Tory Treasury chief secretary-designate, warning the public sector he plans to squeeze £60bn a year worth of waste and low productivity out of the system.

It would never be tolerated in the private sector, said Mr Hammond, a decent man whom some senior colleagues regard as a bit naive. Payment by results will be extended - “if you don’t deliver, you don’t get paid”, he told reporters.

Surely that means schools, hospitals and prisons might go bust, I asked him. No. But expect failed management teams to be replaced, replied Mr Hammond. How we hacks chuckled.

“In my company [a global media giant] junior managers spend a lot of time deceiving senior managers to meet spurious targets,” explained one reporter.

“The CQC is confident it’s right. Look at the number of trusts coming out and refuting Dr Foster’s assessments,” one health official tells me this week after the Basildon and Thurrock Foundation Trust controversy spread to other hospitals.

It won’t be that straightforward, it never is. Dr Foster’s 5,024 “low risk” deaths, those 82 wrong operations, are all troubling. So was the CQC’s own spot check discovery of “blood-spattered” walls at Basildon.

The Daily Beast has uncovered hanky-panky on the wards too (“Hospital chief in love nest storm”) and confirmation that FT chiefs are still getting generous pay rises - despite some spotty performances. As with those bankers, “performance-related pay” has been exposed as a bit of a fraud. Fleet Street has it too.

More worrying for future ministers should be reports that town hall chief executive officers are listening to Phil Hammond’s threats to their pay and perks and wondering if retirement or the private sector would be a better option.

After all, David Cameron’s much vaunted market medicine works both ways: good managers have market value.

Gloomy or what as November downpours lower spirits? So let me end on a more upbeat note. Mike Richards’ report that Britain suffers 10,000 avoidable cancer deaths is an example of positive transparency, a challenge to GPs, primary care, hospitals and - most important - to patients that we can do better.

Five years ago I lost a friend to a cancer that five GPs had missed, but a busy A&E doctor spotted instantly and admitted him - too late. Last week I posted the bowel cancer screen samples for which I’d been asked, unsolicited. Today I got the all-clear. Thanks, NHS.