HSJ’s roundup of Friday’s must read health policy stories

A worrying gap in the NHS’s knowledge

One of the questions prompted by the leaked Southern Health Foundation Trust report this week was whether the problem is limited to only one trust, after it exposed a gap of knowledge about quality of care.

In an analysis piece, HSJ correspondent Shaun Lintern says that the concerning thing is that as things stand, NHS England, regulators and ministers “just don’t know”.

He writes: “NHS England has no way of knowing if the governance problems identified in the leaked draft report on Southern Health are present in other mental health and learning disability providers.

“There is also no way for regulators or ministers to know whether these apparent process failures, including those involving the trust’s board and leadership, had an impact on the actual quality of care patients received.”

The leaked report – commissioned by NHS England and compiled by the audit firm Mazars – claimed the trust investigated just 1 per cent of the deaths of patients with learning disabilities – a figure health secretary Jeremy Hunt described as “totally and utterly unacceptable”. The trust accepts its processes were not adequate and says it has made improvements, but disputes many other aspects of the report.

Lintern warns there is a risk the furore around numbers and methodologies distract from getting assurances over the quality of patient care at Southern Health and beyond: “Mazars did not examine the actual quality of care patients received, and therefore there can be no assurance that care quality was unaffected.”

A debate is now raging over whether the trust is the victim of a poor review, a canary in the mine for systemic issues in the mental health and learning disability sectors, or a genuine outlier.

A possible solution, or at least a first step, would be to use section 48 of the Health and Social Care Act 2008. This allows the Care Quality Commission to carry out a special investigation of a care provider looking at aspects of the provision of care over a specific period, HSJ’s reporter says.

CQC told it ‘requires improvement’

The Care Quality Commission is “not yet an effective regulator”, according to MPs

The much feared Commons public accounts committee published a report on the CQC on Friday, raising concerns about the consistency, accuracy and timeliness of inspection reports and high staff turnover.

It highlighted a number of issues HSJ has covered closely over the last year: the CQC’s recruitment difficulties; its delayed inspection pipeline and missed targets for publishing reports.

The committee also raised concerns about the CQC taking on (at Jeremy Hunt’s request) the duty to assess trusts’ use of resources “before the [CQC] has the capacity to implement it and while it is struggling to fulfil its existing responsibilities”.

Furthermore, it could be carrying out this task against the backdrop of a lower budget (although the CQC may make up cuts to its government grant by hiking provider fees).

The report concludes the CQC “is behind where it should be six years after it was established”.

While the committee says the CQC has made “substantial progress” since 2012, chief executive David Behan, and incoming chair Peter Wyman, will be under pressure to show the regulator has made improvements next year.