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The CQC cover-up (3)

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I am afraid the i‘s view of Mary Dejevsky does not quite match mine. On Friday she came out with this take on the CQC scandal:

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The thesis is that women who do manage to get to the top are unfairly treated and sacked for things that men would never be sacked for. The three paradigms are Cynthia Bower, Margaret Thatcher and Julia Gillard.

This is one of the more bizarre theses I have read. The three cases are totally different. Cynthia Bower seems to have been well-meaning but overpromoted. Look at this interview by John Carvel in the Guardian 1 April 2009 on her first day as CEO of the CQC. He asked her about her three years as CEO of NHS West Midlands, the Strategic Health Authority (SHA) responsible for overseeing Mid Staffordshire NHS Foundation Trust, which ran the Stafford Hospital (estimated to have killed around a thousand patients unnecessarily in the period 2005-2008):

Bower was reported to have said that the poor standard of emergency care at Stafford “wasn’t on my radar”. But what is the point of having an SHA if it does not have a good radar system?

Far from ducking the question, Bower spends longer on the answer than any other part of the interview.

She says the SHA responded decisively to evidence that several trusts in the West Midlands had high “standardised mortality rates”. It commissioned an investigation by analysts at Birmingham University, who audited more than 1,000 cases across the region, and found that patients who were gravely ill when they arrived in hospital were recorded as low risk. Some died, and this skewed the risk-adjusted death rate. The problem at Stafford was due to poor information systems, not poor medical care – or so Bower was told. She says her main concern at the time was the figures for one of the region’s other hospitals.

The answer is less surprising than her body language while giving it. She seems devastated that such a thing could have happened on her watch and, at one point in the interview, she lowers her head into her hands and talks through her fingers, recalling in fine detail the sequence of events. She comes over as a woman with a strong sense of duty who may find it hard to shake off the cares of office when she goes home at night.

“… from the point of view of the SHA, we did a thorough piece of work. When I say it was not on my radar, I mean that nothing I saw told me those things were happening.”

I am quite happy to accept that she cares deeply. But that is somewhat beside the point. Competence is the issue. She failed to analyse the figures properly. Well, figures can be tricky, but plenty of alarm bells were sounding. Irrespective of the figures, she should have got out to the hospital and talked to enough people to figure out what (if anything) was amiss. She didn’t.

Bizarrely, she blames the trust board for not dealing with it. Of course, she is right that they were primarily responsible. It is precisely because (1) we know that those primarily responsible sometimes fail, and (2) it is important to have a low failure rate, that the SHA had oversight. An SHA which just says periodically “please tick this box to confirm that all is ok” is useless. She was expected to do more than that.

It is certainly true that Gordon Brown is partly responsible for the CQC mess (her second disaster). He went along with the fashion for “light touch” regulation. There was no obvious reason for amalgamating the three old inspectorates (Healthcare Commission, Commission for Social Care Inspection and Mental Health Act Commission). They inspected organisations of three radically different types. The amalgamation seems to have been conceived as a way of saving money and reducing the burden of regulation.

The CQC was given a ludicrous timescale for vetting and registering over 40,000 organisations. In each case it could register unconditionally, register with conditions or refuse to register. Bower probably had inadequate resources for the job. She failed to complain about that and ended up botching it. In her recent interview with Jon Snow she made the same bleat about how the trust board at University Hospital Morecambe Bay should have told her about the problems. So three years later she still does not seem to have grasped that she had taken on a job which required more than asking 41,000 institutions to tick a box saying all was well.

Anyone, male or female, behaving like that deserved some public pillorying.

The case of Margaret Thatcher is totally different. She is widely recognized as one of the greatest prime ministers of the twentieth century. She successfully put through a radical programme of reducing union power and privatising public sector businesses (like the telephones). She was prime minister for 11 1/2 years.

Yes, in the end she got chucked out. That almost always happens in a democracy. Churchill was chucked out. The only person I can think of who wasn’t was Harold Wilson, who resigned unexpectedly a few days after his birthday in 1976. No one has ever quite figured out why. One theory is that he saw the early signs of dementia in himself, but there were still few public signs of it ten years later.

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Julia Gillard is different again. Kevin Rudd was prime minister of Australia from 2007 to 2010. He defeated the centre-right coalition led by John Howard who had been in power since 1996. Rudd’s Labor party got 83 seats in the House of Representatives, compared to Howard’s 65. In the Senate (where just over half the seats were contested) he ended up with 32 seats of of 76, but the Green’s supported him.

For reasons I do not begin to understand properly, Rudd suffered a loss of confidence among his MPs and Gillard challenged him for the leadership of the Labor Party. At the last moment Rudd resigned and she was elected unopposed. Two months later she held a snap election. She lost a few seats, but survived as prime minister with the help of the Greens and independents.

The Labor MPs again got restive, fearing bad results in the elections due in September, so Rudd challenged her for the leadership and won the ballot earlier this month. Gillard was forced to resign as prime minister, allowing Rudd to take over.

There was clearly a good deal of enmity between Gillard and Rudd. But I totally fail to see why this was an example of women being treated differently from men.

Oh, Dejevsky also mentioned the Sharon Shoesmith case:

… director of children’s services in Haringey when Baby Peter was murdered, despite 60 visits in eight months from social workers. Shoesmith was singled out in the Ofsted report, pilloried in the media, and summarily dismissed on the orders of … Ed Balls. This was later ruled unfair by the appeal court.

That is simply misleading. The Appeal Court ruling was narrowly on the way that Haringey had dealt with her as employee after Balls had (quite correctly) removed her from her position as director of children’s services.

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