Friday, 4 December 2009

Hospital regulation: CQC vs Dr Foster

Personally I have no confidence in either the Care Quality Commission or Dr Foster. One is a quango run by government appointed stooges and the other is a private firm that has been very cosy with certain government figures in the past. In fact the history of Dr Foster must be understood to realise just what vested interests are at play here.

A big problem is that the CQC is clearly an ineffective regulator. Their inspections are announced and can therefore be sidestepped quite easily by failing hospitals. There are also a number of problems in that whistleblowers are not protected and are in some cases being gagged by their NHS contracts.

Dr Foster is also far from neutral and its methods are far from robust. Dr Foster relies on the HSMR (Hospital Standardised Mortality Ratio) and this is not a reliable measure. For one thing hospitals serve very different populations and for another the HSMR can be fiddled by dodgy coding. The HSMR also only counts those that die in hospitals, so if you can discharge your patients before death then the HSMR will notice absolutely nothing wrong.

It is clear to me as a professional that works in the NHS that we need much better and much more robust hospital statistics that are independently gathered and analysed by a neutral group of proper statisticians with no vested interests. This would be the best way of rooting our problems with our health care system. As things stand the government regulator is useless and the statistics out there are rather crude and unreliable, trust the CQC or Dr Foster at your peril.