Tales of the unexpected

Magnifying-glassWe can’t have high-quality CQC inspection teams and not expect to pay the price, Kevin Lewis says.

Daniel Finkelstein, the political commentator who regularly graces our TV screens, not to mention the opinion pages of The Times, commented that Halloween seems to be celebrated more than Bonfire Night these days. He explained: ‘Years ago you would knock on someone’s door and they might or might not be pleased to see you. It was a bit like canvassing for the Conservative party. Now people leave out lighted pumpkins and if you see one you know you are game on for a mini Mars bar.’

This set me thinking about whether the illuminated pumpkin was designed to ward off evil spirits, ghosts and ghouls, or give them the thumbs-up that you are ready to receive them. I then wondered if we could usefully apply the same sort of thinking where the Care Quality Commission (CQC) is concerned, so that the clipboards never cross your threshold on a bad day.

Damned if you do…

I must confess to having found myself feeling some sympathy for the CQC recently. The CQC must be developing an increasing affinity for the dental profession because whatever it does, it seems to get a pasting from someone or other. Welcome to our world.

The CQC finds itself having to walk a fine line between being criticised for not being sufficiently thorough in its inspections, and being criticised for being excessively thorough. A lot of the early criticism when it was parachuted into dentistry surrounded the fact that inspectors were arriving into dental practices with no knowledge of what happens within one. But if the CQC responds by expanding the inspection teams to include people who actually know what they are talking about, it gets criticised for wasting money.

The latest chapter in this recurring saga was a Freedom of Information Act request for the release of information to explain the 400% overspend in the CQC’s 2014-2015 budget. An overspend on this scale is more difficult to dismiss on the grounds that you stopped for lunch at Mcdonald’s or carried out a few extra inspections, which is why the Health Service Journal (HSJ) served the FOI application, which will have had HSJ readers chortling into their camomile tea.

It turns out that, in order to address previous criticisms, the CQC is fielding larger and more specialised teams when inspecting hospitals and other large healthcare facilities. This in turn necessitates having to transport inspectors from one part of the country to another, and also put them up in hotels and feed them. The figure quoted for overnight accommodation was just shy of £1 million for the year – about £28,000 per team per inspection, which at first sight would not suggest ‘Travelodge’ to the untrained eye. Not all of the inspection teams involved 100 or more people – but some did, so the expenditure starts to look a bit less extraordinary.

I like to see public money spent wisely and responsibly as much as anyone else does, but I am tempted to suggest that we can’t have it all ways. We either want a credible independent inspectorate and are prepared to pay for it, or we don’t.

How was it for me darling?

Health and social care has moved into the real-time patient feedback arena, but not without some significant teething pains. Social care – in common with a lot of primary care dentistry – is at one level a deeply personal, human interaction. But it is also big business. So any feedback portal runs the risk of conflating very different issues including the standard of care, the service delivery, the quality of the overall experience, cost and value. It is also relevant to consider that this may be health and social care, but it is also a competitive market.

It is probably also fair to observe that real-time feedback is not yet deeply embedded in the psyche of delivering and receiving healthcare. What appears to be true is that a member of the public is probably more likely to make a posting about a restaurant or hotel they visited, than about the hospital, GP medic or dentist they visited.

This is not to say, however, that the same member of the public would not welcome the opportunity to read the reviews of others regarding potential healthcare providers, and those working in this online arena believe that once you have personally benefitted from being able to do this, you are more likely to make the effort to post reviews yourself in order to assist others.

Stephen Burke, the co-founder of the Good Care Guide, points to the wide gulf he sees between the consumer demand for access to reviews and the availability and willingness of potential reviewers. ‘People expect more transparency than they used to’ he says, ‘and they want to see what others say about a service before they make a purchase, the challenge is changing the culture of care so that people leave reviews in the same way as they leave reviews of hotels and restaurants.’

Martin Green is the chief executive of the organisation that represents independent care providers in England (Care England), in a sector where real-time feedback has already gained quite a lot of traction in the current consumer era of ‘information and choice’. He highlights one of the pressing concerns that gains added importance for those who are registered with one of the healthcare regulators such as the GDC, GMC or Nursing and Midwifery Council. This is not an issue that hotels and restaurants need to worry about.

‘One of the issues with Tripadvisor-type websites’ he suggests, ‘is ensuring that the comments left are from genuine service users, or their families, and not from competitors or disaffected former staff.’

A flash in the pan

When in my previous column earlier this month, I brought to your attention the looming sh*t shortage predicted by Oxford University researchers, I could hardly have anticipated the news that was to follow so swiftly in the wake of this research.

Another researcher – this time, from Cardiff University – has struck gold while prospecting in the sewage treatment plants of Thames Water, or more accurately, in the residue from the incinerators used as part of the process. And we are talking rather more than a mere flash in the pan here (so to speak) because across the country the scale of this gold strike is a glittering £13 million per annum.

Naturally my first reaction was to think how many swallowed, ingested and – shall we say ejected? – gold containing dental restorations this amounted to.

I don’t know the answer (and nor do I care to find out) but it certainly puts ‘clinical waste’ into a very different light.

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