Addenbrooke’s Problems Are National

Polly Toynbee still has her uses:

A mighty hospital is today felled with one blow.

Addenbrooke’s, part of the Cambridge University Hospitals NHS Foundation Trust, has been downed by the Care Quality Commission (CQC), plunging from top ranking to inadequate. 

Today this world famous institution goes into special measures, taken over by an “improvement director”. The chief executive and finance director jumped. 

Dr Keith McNeil, headhunted from Australia, was only chief executive from November 2012 – but that’s normal: 30 months is now average survival time. He joins a roll call of NHS heads sacked or fled, leaving 33 trusts with no chief executive.

Earlier this month, researching the crisis in the NHS and social care, I chose Addenbrooke’s because of its previous excellent CQC report.

I found a hospital under severe pressure, overrun with emergency patients and admissions of over-80s up by 23%. At the morning bed state meeting, ward managers juggled available beds against the inflow of new cases.

The trust had just declared a “significant critical internal incident” – jargon for no spare beds.

All non-emergency admissions were cancelled, ambulances diverted elsewhere and the day surgery closed and converted into a ward.  Only cancers, two liver transplants and A&E emergencies were taken in.

There was another “critical incident” on Friday. It keeps happening. At the daily staffing meeting, nurses were shifted around to cover wards under most pressure.

The shortage everywhere is grievous, after the government cut nurse training, while blocking visas to non-EU nurses. 

Trying to cope, Addenbrooke’s spends £1.2m a week above its income – with an expected overshoot of £50m this year. 

Forget preserving NHS funds, this trust has lost £40m from various sources. Soaring hospital debts are expected to reach £2bn this year. 

McNeil says what I hear from other chief executives: they are forced to choose between debt and risking quality, they choose debt every time. 

But what made the CQC condemn Addenbrooke’s so brutally? For “inadequate” you would expect horror stories – deaths, injuries, infections and neglect. But there’s none of that. 

On the contrary, patients here have a better chance of first-class treatment and less risk than almost anywhere, whether suffering from a broken toe or needing a state-of-the-art complex procedure. 

The CQC report also gives an “outstanding” rating for caring: “Staff were hard-working, passionate and caring throughout the trust, prepared to go the extra mile for patients, but having to swim upstream against the pressures they faced.” 

And 90% would recommend the hospital to relatives, well above average. 

Inspectors did find unacceptable waits in dermatology and ophthalmology outpatients, where some people had waited for two years. 

They found a build-up of anaesthetic gas in the birth unit, obliging staff to open the windows – but no horror tales of actual harm, no melanomas or glaucomas missed. 

The systems behind the scenes were “not robust”, managers not aware of some frontline issues, needing improvement in procedures and record-keeping. 

These criticisms might mark them down, but it’s unclear what merits “inadequate”, “special measures” and defenestrating executives. 

The report says: “Inspectors found a significant shortage of staff in a number of areas, including critical care services.” But what can an “improvement director” do that the chief executive and finance director were not striving for already? 

Doctors have held meetings to call for McNeil’s reinstatement – but in Jeremy Hunt’s NHS culture of fear, many are afraid to give names. 

Addenbrooke’s problems are national. 

Under Hunt’s torturing inspection regime, just look at the tally of 98 CQC inspections. Of acute trusts, they found just two outstanding and 16 good while the rest fail, with 68 “requires improvement” and 12 “inadequate”.

Is the CQC on a mission to find most below average? What is the benchmark when so many fail?

Inspections seem to happen in some stratosphere above the mundane reality of the most drastic funding crisis the NHS has ever known.

David Cameron kept his promise to raise NHS funds – but only by a homeopathic 0.8% a year, despite a growing population, especially of the old.

The UK spends less on the NHS than the EU average, with three times fewer beds per head of population than Germany.

Why send in a CQC hit squad to beat up NHS managers struggling against impossible odds?

The CQC (costing £224m, half paid for by its victims) sent 60 inspectors for four days to Addenbrooke’s, after demanding mountains of documentation. 

It cost the trust more than £100,000 – but it probably didn’t spend enough, as some trusts, at great cost, call special consultants to rehearse a CQC presentation. How mad is that?

It all makes perfect political sense to Hunt, who poses as the patients’ champion, pitting himself against the NHS by “lifting the lid” on its failings, with a board in his office listing NHS “never events” or events that should never happen – but there’s nothing to praise brilliant events.

The CQC is his provisional wing, sent out to knock down one NHS service after another, to distract from the worsening NHS finance and staffing crisis.

The £8bn promised in the election is not provided until 2020, and is £22bn short of what NHS England says it needs. 

Pretending that £22bn will come from “savings” from the likes of Addenbrooke’s is not delusional, it’s just dishonest.

The evangelicals of the CQC are useful to blame the NHS and its managers instead of the government.

McNeil is not creeping away shamefaced, not gagged, but standing and fighting back – as should more chief executives before their heads are knocked off too.

He calls Addenbrooke’s quality of treatment “phenomenal”, the inspection/regulation regime “Kafkaesque” and the NHS wasteful of money on its purchaser-provider commissioning system.

The cuts in council social care are now blocking 200 of his beds, he says, with people lacking care at home.

The CQC, he says, “has lost all sense of proportion. We do half a million operations a year, with excellent outcomes. Of course we won’t get everything 100% right.” 

That’s common sense, but those are brave words in the current climate of bullying and shame in the NHS, fostered by Hunt and carried through by his CQC.

No wonder there’s a shortage of people willing to take chief executive posts.