Daily Insight: Feeling the heat

A trust chief executive has warned that the “heat” of the Care Quality Commission’s inspection regime still focuses on individual organisations, rather than systems, driving the “risk aversion” partly responsible for the emergency care crisis.

Mid Yorkshire Hospitals Trust’s Len Richards told a House of Lords’ committee that care and nursing homes in his area had declined to take patients ready to be discharged from hospital last winter over concerns their CQC accreditation would be at risk.

He continued: “We went to the CQC to try and create some flexibility. Their perspective was very much of an independent regulatory body that would look at the organisation and not look at the system. I think we’ve got an awful long way to go there.

“I think regulation does drive risk aversion… [and] the heat of regulation right at the moment is on individual organisations.

“Therefore, when the CQC come and look at my organisation, they will talk about congestion in the A&E department. They won’t talk about the assessment that we made around there being a greater risk in the community if we didn’t offload ambulances.”

When asked about Mr Richards’ comments, a CQC spokeswoman, said: “No one service or sector alone can unblock the current gridlock in care – and it is clear that system-wide solutions are needed.”

Licence and legislation, please

The licensing regime, a set of conditions trusts and providers of NHS services must sign up to, might look arcane at first glance. But NHS England has just proposed a series of amendments that will give it more power to take action when it deems trusts – or private health providers – are failing across a series of metrics.

Extra duties to collaborate look like a routine reflection of the Health and Care Act reforms, but contain lines that could become a stick to beat spendthrifts. Trusts will have to stick to financial plans set at a system level, to ensure no one spends “more than their fair share of NHS resources” – an ambitious goal, given emerging deficits across the sector.

Meanwhile, it’s difficult not to read a section that strengthens oversight of private health groups providing NHS services without thinking of the string of high-profile failings at units run by independent mental health providers. The new rules will let the NHS head office step in over quality concerns.