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Editor's blog Thursday 2 June 2011: NHS quality regulation doesn't work; try this instead

If we needed reminding that quality regulation in the NHS is unfit for purpose, then the ongoing Mid-Staffs public inquiry and the recent BBC Panorama undercover documentary into abuse at Castlebeck’s Winterborne View residential hospital provides all we could need.


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It is depressing but instructive to note that there had been several attempts to contact the CQC by the former member of Winterborne View staff who went to Panorama and to managers, by the CQC’s own admission.

Regulation of healthcare simply seems not to work very well. It’s a difficult task, I suspect, but not an impossible one.

The professional regulators are not held in terribly high regard. Part of this is because there is something in healthcare (probably in every profession) that makes staff massively reluctant to inform on bad behaviour or poor practice by one another.

What then is to be done?

There are some online resources such as Patient Opinion and I Want Great Care, whose ideas have been repurposed by NHS Choices. It’s hard to be clear what their reach is, and they’re eminently hijackable by the biased and the rivals (just as any online feedback service can be) - but they are a useful contributor to the jigsaw.

The bigger issue is the national picture, and I think there is a fairly simple solution.

Abolish poorly-functioning national quality regulation, and give the money as a subsidy with a range of conditions to local newspapers. A small sum needs to be paid to some independent regionally-based staff, to monitor and follow up on the output.

There will of course be objections that there are rubbish local papers. This is true. But there is also often some degree of competition, and it is certainly possible to tell a good, properly-written paper from a bad churnalistic freesheet. More to the point, quite a few local papers are excellent but badly under-funded.

The advantages for local papers are that a subsidy to deliver adequate health coverage would reinforce their curiosity about local provider (and indeed commissioner) performance. There are many good stories to be had.

Local newspapers’ journalists and editors also have to exist in their community on an ongoing basis. They cannot ‘turn-up-and-burn-up’, as metropolitan or national media can and do to contacts. It’s a good way if giving them a real stake: some ‘skin in the game’.

There are also the pitfalls of bias, grudge-settling and other such drivers – but the press are used to dealing with these motives, and to presenting both sides of a story.

More to the point, the British press knows that it is subject to some of the world’s most stringent libel laws, in which absolute truth and the public interest are key defences.

If you look at the local press in many of the big scandal areas, such as Mid-Staffs or Maidstone and Tunbridge Wells, you find that they have had the story long before it 'broke' nationally. They seem to me to outperform the Healthcare Commission and the Care Quality Commission.

Time for change.