If only he had worn a suit and tie….

jackboots-2The CQC Borg will decide….

…..in 2014 when the inspectors last came. He had explained his philosophy and modus operandi, talking of medicine as an art form, “being a human being so patients feel they know well me enough to trust, while maintaining boundaries – compassionate detachment, I call it.”

“On that occasion,” he will recollect later, “they seemed concerned with seeing whether I was running a healthy, happy, well-functioning practice. They looked at feedback forms, talked to patients and made intuitive judgment.” They gave him a glowing report.

This time round…read here.

Michele Golden, head of inspections for London at the Care Quality Commission, says:

“We know, from various inspections, that patients will say how happy they are, and it may be that their doctor is a very nice person, but that doesn’t mean they understand if the system is actually unsafe for them.”

It would seem that Nanny may not always know best…but she holds all the cards.

There has never been a serious complaint against him, and he is exceptional in not having been called for a disciplinary hearing in all his 40 years as a GP.

Although he could continue practising as a doctor, his surgery must close with immediate effect.

The CQC and Mumsnet…

local_logoCQClogo2I’m not sure what to think about this to be honest. On the one hand the CQC really must listen to opinions from patients (as opposed to “consumers of services”, however they have had such an appalling introduction to dentistry and general medical practice where it is quite clear that not only did they fail to understand the professions and they way that they functioned but they also brought with them preconceptions about the “services”.

Their opening statement doesn’t do any favours; “we believe passionately etc etc” is just the usual verbiage that we have come to expect from government departments who are already agenda driven. There isn’t enough money for the universal care that they suggest is or should be available for all from the great British religion that is the NHS, but no one has the guts to admit it.

Asking for on-line opinions does tend to bring out the trolls, gives oxygen to people with an axe to grind or just allows those with a dislike / resentment of dentistry to have a go.

Some of the comments reflect the lack of understanding of the NHS regulations, dentists’ training, changes in contracts and the benefits of private dentistry.

On the flip side it also shows how poor many practices are at communicating effectively with their patients.

The survey is here. Take a look and make a comment, you might win £100 for your favourite charity.



Dafydd’s story

A short story for our times:

Vodka had never been is tipple but it was doing the job now. A beer man by habit and taste. His father had given him the advice early in life “let your stomach control your intake”. Dad’s favourite became brandy as he aged. To Dafydd the modern phenomenon of shots had never appealed, leading as it did to falling over drunkenness. He had grown up believing that the measure of a drinker was how well they held their booze not how drunk they got.

The vodka was hot but light and was doing the job.

Dafydd smiled as he thought about TLAs and their role in his life. Those TLAs or Three Letter Acronyms started with BDS – the light at the end of the 5 year university tunnel.

He had always thought that a university education would something wonderful; discussions about the meaning of life, time to think and debate and the opportunity to expand one’s intellect. Instead dentistry was a sausage machine with elements of confrontation and humiliation which left him feeling that he was never quite good enough.

The five years introduced more TLAs – DSA, MOD, RCT, PJC, BJC, TMJ, FGC & IDB the list seemed to go on forever.

The BDS led to being accepted by the GDC, the shadowy “big brother” that must always be obeyed even if its actions and behaviours in recent years made it lack credibility. More money for less  accountability and even less representation, more bureaucracy more interference. But they wouldn’t be getting their £576 next year.

First had come hospital jobs, the one as an SHO at KGH the best, happy years treating trauma from RTAs and alleged assaults whilst living in the artificiality of the hospital residence. But then came the FDS and he had exhausted his patience with exams so there wasn’t the devotion that would lead to fellowship of the RCS.

General practice beckoned; not a bad direction, 90% of dentists become a GDP, why not you Daf? So came the PCT and SHA, getting approval from the DEB for a PGT. From day one he was uncomfortable ensuring the available treatment fitted the patient. In order to earn money in the NHS one had to know “the system” and make it work for you. If you’re giving an IDB then better to do two MODs he was told. Ensure you don’t just do a S&P, do a PGT if you can. Don’t do anything that might make the DPB /DEB suspicious. Suspicious of what? He was hoping that he was treating every patient, every time on their merits.

He soon realised that people were frightened of him and what he did but not how he did it. His hospital years had left him pretty slick with needles for IV sedations so he saw the “phobics”. Tourniquet, open  & close your fist, butterfly into the AC fossa and off you go. Some of the early days were pretty hairy with cocktails of drugs but Hypnovel sorted that out.

Hypnovel, good old Midazolam what a lovely drug, profound amnesia, oblivion. Finding his own AC fossa had been easier than he would have thought.

Eventually he had started his own practice, doing things his way, his patients liked him and his earnings were good but there was still something that gnawed away inside him, the gremlin on the shoulder whispering “you’re not good enough” in his ear. He had worked hard as he had been taught, was always available for patients preferring to do his own on call. For many years a week was as long a holiday as he allowed himself blaming cash flow but really not wanting to let anyone else have to see “his” patients.

It had been another of those TLAs that had been the last straw. The Care Quality Commission or CQC, really was the bogeyman. It arrived untested and uninvited to hammer General Dental Practice into the pattern and shape that it decreed.

Dafydd had spent hours going through protocols and procedures, night after night at the practice. His wife suspected him of having an affair, “chance would be a fine thing” he said, and he had forgotten what his kids bath and story time was like. Some of his mates had bought one of the off the peg solutions but Dafydd was a perfectionist, he had to know what was in his practice manual, he had to have his mark on his practice’s policies.

His eyelids were heavier now, the peak flow from the Quantiflex machine adding to the feeling of beautiful relaxation.

The inspector had rung yesterday to give the polite 48 hours notice. His receptionist had come and told him about the call and seemed to think it funny about his panic, none of them seemed to realise how important this was. His nurse had admitted to him that she had stopped flushing the chair water lines a month ago and couldn’t see the point of keeping the autoclave records. “How can you expect me to be cleaning instruments, bagging them, dating the bags in one room and chaperoning you at the same time in another, Dafydd?”

She was right of course, it couldn’t be done and reach his UDA targets too. He was doing the wrong job, everyone else had coped with the changes, he was obviously a failure.

Before reaching for the bottle’s blue screw top, he had laid out all the protocols one by one on the reception desk. He had telephoned his first patients for the next morning and apologised for having to postpone their appointments.

Lying back comfortably in the memory foam of his dental chair 70ml of 90 deg proof vodka coupled with 30mg of Midazolam and Nubain running through his veins all topped up with Nitrous Oxide; he felt no more pain.

No frustration at the BDA for not protecting the small guy.

No anger at Barry Cockcroft over the new contract.

No resentment for the PCT that had allowed the 8-chair corporate to open across the road from him.

No fear of the CQC.

Dafydd felt nothing at all.

The next thing he knew was John Humphreys’ voice. Humphreys the Cardiff High School boy. Yet another who had made it from Splott – like Terry Nation the man who invented the Dalek. It was 6.50 am, he had the school bus run to do before heading for the practice. The practice! He often wondered how long he went between clock radio alarm and thoughts of the practice – sometimes (especially if Humphreys was grilling an NHS representative) the thoughts were there before his eyes opened.

It hit him, today was CQC day. Showtime Folks! Not a bad hair day today. Time to shine; time to show that his was a pride of practices. Sod the CQC, stuff the PCT & *****ks to the GDC. He had finally bitten the bullet two days earlier, he was holding a beauty contest with the three top plan providers over the next fortnight. His days of deference to the NHS apparatchiks were behind him. A late cancellation on Tipton’s restorative course had cemented the deal with himself; he had the second half of his career to consider and it wouldn’t be chasing UDAs.

But there was something troubling him, a disquieting image at the back of his mind that he couldn’t quite recapture.

Sod it! No time to worry about dreams.

Free Guidance on CQC Inspection from Practice Plan & Apolline

Sounds good to me…

Practice Plan News Flash!

You will be very interested to know that Practice Plan, in partnership with Apolline are offering free guidance on CQC inspection visits. The guidance is based on practice visits that have already taken place so really cannot be missed!

Practices can access this free information through BoD website, if they are a registered user, or, if a Practice Plan member through the PPHub. If not a Practice Plan Practice they can find out more at  www.bodhub.co.uk/cqcinspectionsguidance.

The guidance is being offered under the BoD brand and I have attached the Guidance document below for your info, but this is for your eyes only and not to give to any practices if that’s ok.

We really just want to spread the word, as its such a great opportunity, so if you wouldn’t mind whilst your out and about in yours or our practices letting them know about this great offer and if there are interested just tell them to contact Practice Plan direct or if not with Practice Plan they can just register with BoD, we would really really appreciate it !

Thanks again.

I do wish I had said that…#2 – Is the Boa of Bureaucracy killing Professionalism?

A recent posting on GDP-UK by Tony Kilcoyne

Dear All,

The essence of being a Professional is to put patients’ best interests first, before our own, before any systems we may work within and even before Government Policy and experimentation.

Yet it is clear such Professionalism is under constant attack and being compromised – a classic example in Dentistry is the débâcle of NICE guidelines on dental recalls being imposed upon NHS Dentists, where they have to send as many patients as they can away for two years to help bureaucrats hit centralised dental access targets before 1st April, even though this increases risks of disability, disfigurement and even death for those who can no longer have their Oral Cancer checks annually at their dental check-ups. (BMJ article link here)

Dentistry is a ‘fixed-budget’ service so after fixed-overheads are paid out only then is any funding left to treat the same number of people. Even in Private Practice in these recessionary times this is true, because one cannot simply just raise one’s prices in a free market without suffering less turnover, which has tended to happen with more Dental Practices struggling or even going bankrupt now than at any other time in our history.

So if the fixed costs (incl. bureaucratic) increase, patient funding decreases inevitably – yet what does this Coalition Government do having promised to reduce Bureaucracy for healthcare workers so they can spend more time and resources on frontline care for patients – yes it massively INCREASES the Bureaucratic burden on Dental Practices instead, by imposing the CQC upon an already GDC regulated Profession that was already held accountable for it’s premises and management systems ( GDC Publication here) with plenty of FtP disciplinary cases to show how registrants can be struck off for such breaches.

It was the English DH who made-up the case for the CQC to Ministers on a cost-saving basis, but it now is becoming apparent his was very poorly done and badly judged, if the latest comments by the cross-party Parliamentary Accounts Committee into the catalogue of CQC poor performances is anything to go by.  (Read report here)

The above report concludes the CQC cannot even adequately govern it’s own poor performances, let alone that of others, yet those who gave them Dentistry to govern have no responsibility or accountability for their poor judgement or the knock-on effects at all

There simply isn’t room here to list all the waste & additional meaningless paperwork policies we have been forced to waste limited time and resources with CQC, which ultimately one can only conclude MUST have harmed patient care overall in our fixed-budget systems.

Do I even mention HTM 01-05 and it’s experimental and costly imposition upon Dental Practices too, where hospital systems that kill 3000-5000 people a year are being imposed upon dental practices who kill zero people annually? This then compounds things even worse in other Countries like Northern Ireland who copy and go to further unnecessary extremes, forcing dental practices to lose a Surgery that COULD have been treating patients to create an LDU, or be closed down! Either way precious limited resources are diverted away from providing frontline care and this in a Country where their young child dental health is one of the worst in Europe and set to suffer more.

When I think of National statistics that show the third most common MEDICAL reason for ANY child to be occupying a hospital bed is rotten teeth, (Daily Telegraph article here) yet we are wasting Millions of Pounds and Millions of Professional hours on Bureaucratic experimental folly like above, it makes me want to cry as a caring Professional, yet we are all dis-empowered from stopping such policy-based misery continue year after year

The CQC, RQIA, HIW, HIS and other regulatory bodies are very keen on child protection policies and training within Practices, yet they totally ignore or may even be partly responsible for perpetuating the National-Scale of Child Suffering & Abuse caused by the widespread systematic SUPERVISED-NEGLECT of the dental health of younger children in Society who depend upon Central Policy Planners and Systems, that ultimately ignore and don’t protect them.

Will children born today be still occupying so many hospital beds because of rotten teeth in 5 years time
Almost inevitably, unless we start putting Patients before Paperwork, Scientific-evidence before politicised policy, returning more Professional Freedom instead of the continued tightening Boa of Bureaucratic rules and regulations that pretend to be patient centred ultimately.

What have we learnt from the Mid-Staffordshire Hospital disaster where some 400-1200 extra deaths were caused by unaccountable management systems imposing experimental Bureaucratic policies and centralised targets upon already stretched Professionals? (Daily Telegraph article here)
Nothing it seems and it’s possibly got a LOT worse since then too.

We can wait for a miracle or we can act – where many internal pathways to the DH and politicians are continually met by excuse-making responses to try and justify this continued restrictive trend upon our Professionalism, then we are only left with one option in the Public Interest as a Professional group – Whistleblowing

The Boa of Bureaucracy is ever-entwining and restricting our Professionalism and independence to act in patients’ best interests before those of experimental bureaucrats – whilst we have a little Professional breath left, we need to raise the Alarm so others who have the power to make change externally, can be publically informed and rescue the situation from it’s inevitable demise

The best protection the public have is our Professionalism and independence to raise the Alarm publically – what is bad for Dentists and their Teams is bad for Patients too – that includes the deadly Boa of Bureaucracy in Healthcare.

Yours genuinely concerned,


I do wish I had said that…#1- My life in Bureaucracy

To start this occasional series here’s an excerpt from Beverley Martin’s Blog

My Life In Beaurocracy(sic)

From the age of 14, after reading an article in ‘Mizz’ magazine about career choices, all I knew was that I wanted to help people. I didn’t know how; I just wanted to make lives easier, the way mine sometimes could be made easier. I started studying psychology, from A level to degree level, and although I wasn’t able to use my BSc right away due to starting a family almost as soon as I graduated, knowledge of behavioural science has been immensely useful to me ever since. While my children were little, I worked for voluntary organisations such as the Samaritans and undertook courses in counselling skills, whilst working in retail for the flexible hours and useful extra money. Even my time in retail wasn’t wasted in conjunction with my ‘career plan’. After being taken on by the John Lewis Partnership at the age of 22, I was kept out of sight of the customers for an entire week whilst being rigorously trained in a training suite within the store, which equipped me with the skills to identify and find ways of meeting the needs of the customers I would encounter.

When I began working for the youth service, I loved the idea of identifying specific needs a child or young person may have, in order to be able to meet them  which in turn would help them and make their lives easier. Both my John Lewis and counselling training helped with this. I didn’t love the unfamiliar vocabulary, which sounded disconcertingly like ‘Newspeak’, the language from George Orwell’s novel 1984 to me. However, I acclimatised.  Needs not only had to be identified and met, but outcomes had to be identified, evidenced and documented. Although in fairness, I have no experience of or idea how to effectively manage a countywide youth service, in times of crisis, the youth service response would often paraphrase that of Reg, the leader of the People’s Front of Judea in Monty Python’s ‘The Life of Brian’:  “Right. This calls for an immediate………assessment form”.

Young people, many of whom were blessed with the sort of attention spans of which goldfish would be wildly jealous, found the endless form-filling as tedious as I did. Especially when it rarely led to the outcome they’d been hoping for. “What’s the point of all this” they would ask. If I told you how many times I resisted the urge to reply “I have no idea – but I suspect it’s so you can be fooled into thinking your individual needs count for anything to the government, whilst they can fool everyone into believing they’ve met them anyway.”, you probably wouldn’t believe me.

In around 2007, the local authority decided to roll out an entirely new system, which although was intended to provide a better service for children and young people, had failed spectacularly every time it had been rolled out in other areas – a fact that did not deter them in the least. The centralisation of services, and the centralised assessment form which many users found virtually impossible to fill out accurately, meant that many young people were slipping through the system or being offered services which were inappropriate for them.

At about the same time, the local authority spent many thousands of taxpayers’ pounds forcing youth workers through an NVQ level 3 course in youth work, which involved spending many extra hours of their own time identifying, evidencing and documenting the screaming obvious. Hilariously, just before youth workers realised this was actually mandatory, they had been forced to ‘apply’ to do the course, to justify why they should be allowed to do something they were contractually obliged to do (despite the fact that this was not specifically in any employees contract. Contracts at my local authority were spoken of in the reverent terms usually reserved for the Loch Ness Monster and Xanadu. One employee actually thought they saw one once, which caused great excitement. It turned out to have been a non-contact form).

Many youth workers who had no confidence in their academic skills left the service at this point which was desperately sad for them and the young people for whom they’d been providing invaluable support. However, the local authority were not the slightest bit perturbed, which made sense in 2012 when the entire youth service was deleted……imagine how much more money they would have wasted on those meaningless qualifications if those youth workers had stayed and completed the course! Therefore, despite my love for working with young people, I realised that I was not evidencing or meeting my own personal need; to help them and make their lives easier. I had identified an outcome which I was failing to achieve! The system in which I was working was procedure-based, policy-based, evidence-based and database-based, but not people-based. I was part of a problem, whereas I’d always wanted to be part of the solution.

So I decided to try and fulfil a little daydream I’d had for a while about becoming a dental nurse. It was something that appealed based entirely on the way it would enable me to help people and make their lives easier in certain specific ways, yet appeared to be free of the meaningless beaurocracy involved in youth work.  I was taken on as a trainee by a wonderful, family owned practice whose patient list includes grandchildren of patients who first attended as children themselves. From the moment I first walked through the door, I loved it – it felt warm and caring, and I felt I could do good there. I felt I could help people and make their lives easier, the way mine could sometimes be made easier.


In the three short years since I became a dental nurse, dentistry has become the oral health equivalent of the youth service. An expensive leviathan of a quango, ostensibly a “regulator” (despite that fact that all dental professionals were already regulated by an existing regulator; the General Dental Council) known as the CQC, decided that care homes, hospitals and dental practices were hotbeds of hazard. In an attempt to justify its existence, it demands that dental practice staff have in-depth knowledge of legislation relating to vulnerable adults and children and implement policies relating to everything from infection control (which makes sense) to patient restraint (which does not).

The CQC demands that all staff should be CRB checked – a requirement I could understand as a youth worker, working often alone with young people, but less so as a dental nurse whose contact with children and vulnerable people is ephemeral, who is never alone with children or young people and in times past would have been considered the chaperone for the dentist, instead of an equally suspected paedophile who has to pay around £44 to prove that I’m not. In case anyone is in any doubt, CRB checks, pushed in the wake of the Soham murders, would not have saved Holly and Jessica because Ian Huntley did not work at their school. His contact with them was enabled by his relationship with Maxine Carr, their teaching assistant, who had a previously clean record and would, therefore, have sailed through a CRB check. I think we can all agree that is £44 well spent…….on top of the annual £80 I pay in personal indemnity in case I accidentally hurt a patient and the annual £120 I pay to the GDC to prove I’m not Harold Shipman MkII. That’s despite the ironic and appalling fact that under the watch of the present chief executive of the CQC, well over 1,000 people died as a result of inadequacies and disgusting conditions in hospital in Mid-Staffordshire. A death toll that Harold could only have dreamed about.

It isn’t enough for dental practice staff to regularly check the contents of their emergency drugs kit and keep a log of checks – a check log of the log of checks must also be kept. Just to make sure those divvy dental professionals know how to tick a box. I, as a dental nurse, have to tick a box to state that I have followed the correct procedures for cleaning my surgery at the end of a session. I’m no longer trusted to simply clean my surgery, you see. I have to EVIDENCE it. The evidence of my spotless work surfaces, dental chair, floors and sinks is not at all admissible. My little ticked box, however, is. I must stamp all sealed packets containing dental instruments with the date three weeks hence. After this period of time, the instruments will unaccountably (and I do literally mean unaccountably – despite all the evidence required from dental professionals, the evidence underpinning these requirements is suspiciously absent) become contaminated and need to be re-sterilised even if the packet was untouched and unopened……..unless I was to live in Wales rather than England, where micro-organisms take a whole seven days longer to contaminate sealed instruments. Moreover, if we had a vacuum autoclave, sealed instruments would become contaminated after 60 days in England, whereas Irish micro-organisms become highly dangerous within a sealed packet after only 30 days. How amazing that the government has discovered those pesky bacteria behave differently depending on their geographical location. Of course, aside from the sheer tiresomeness of these pointless rituals , they ensure I spend far less time than I used to in the dental surgery assisting my dentist, looking after and reassuring our patients and doing….well……my job.

As if that wasn’t enough to contend with, all dental professionals must be well versed in the law regarding child protection and have knowledge of the contents of the Mental Capacity Act (MCA) – a controversial piece of legislation which states that even the most obviously mentally incapable patient should always be treated as capable of making decisions relating to their dental treatment unless they, in the small time frame in which we get to see them, act in a specific way – or even dress in a specific way – which suggests otherwise.

Don’t make the mistake of thinking that dental professionals only need to look after their patients, monitor their physical safety, respect their dignity and go out of their way to ensure they leave the practice happy and pain-free – practices where staff cannot demonstrate knowledge of the MCA are judged by the CQC to be failing at “standards of caring for people safely and protecting them from harm” and even judge patients to be “at risk” from staff who have not undergone safeguarding training, or who have not undergone an enhanced CRB check. You’d think “standards of caring for people safely and protecting them from harm” would directly relate to making sure our standards of infection control are adequate, or that our equipment isn’t about to fall to pieces on them. If you did, you’d be wrong. You’d assume dental professionals are there to look after our patients’ teeth. You’d be wrong.

Dental practices have been dragged into the Brave New World. The world I thought I’d escaped when I left the youth service; the world which chased me into dentistry. There is no escape from the stranglehold of beaurocracy, which has led despairing dental professionals to leave the profession, frustrated that they can no longer focus on what they were trained to do. I constantly consider leaving myself, but the thought that it either already has or will shortly infiltrate all professions depresses me enough to conclude I’d be better off staying put. At least this way I still – sometimes – get to help people and make their lives easier. The way mine isn’t being made easier.

I could go on……but that’s about all I have to say – apart from the fact that every time a CQC apologist reminds dental professionals that they are risking patient’s lives by not attending the optional mandatory safeguarding training (yes, it is both optional and mandatory), somewhere in the world, a dental nurse is one step closer to a cardiac arrest. Now, if that’s not a good reason to check the check log of the check log of emergency equipment, I don’t know what is.

Care Quality Commission: a case study in poor regulation – an MP agrees

From Steve Barclay’s blog, Steve is the Conservative MP for NE Cambridgeshire.

Yesterday’s Public Accounts Committee hearing was on the Care Quality Commission, the regulator for the National Health Service set up in April 2009 bringing three predecessor organisations together: the Healthcare Commission, the Commission for Social Care Inspection and the Mental Health Act Commission.  It has a budget of £139 million.

The hearing was like a case study in what went wrong in the last Government’s approach to regulation. The Care Quality Commission is an organisation that the National Audit Office concludes does not provide value for money; diverted huge resource to registration (yet failed to complete this on time); and did not undertake a single new investigation between May 2009 and June 2011 (its first two years). It has not launched a single prosecution because the hospitals it regulates are too big to fail and it has no audit system to ensure that there is consistency in the inspections it undertakes.

It also has no effective controls regarding the training of its inspectors, many of whom are reviewing clinical areas without any clinical qualification. It remains unclear exactly how many inspectors working for the Care Quality Commission have a clinical background and the Chief Executive has agreed to send the Committee a note providing a detailed breakdown. Given that just ten days of training was provided to inspectors in 2009/10 (some of which was e-learning) and that many inspectors work from home, I remain concerned as to whether inspectors are largely reviewing processes rather than having the expertise to question clinical staff. Where clinical staff are working for the CQC, there was no evidence to confirm that their clinical discipline relates to the issues they are inspecting.  For example, a dentist has a clinical qualification but will be less effective, I suspect, in inspecting the deaths of babies on a maternity unit than someone with clinical experience of working on such a unit.

One of the most glaring faults with the Care Quality Commission which I highlighted yesterday is the conflict between its role as a regulator that promotes whistleblowing and a culture of openness within the NHS, and the gagging clauses imposed on departing CQC staff by its own Chief Executive. It is quite remarkable that a distinguished member of the CQC’s own board, who has 11 years experience as a Mental Health Commissioner, stated “My endeavours to provide robust scrutiny and challenge led to my professionalism being challenged.  Doubt was cast on my mental health and my performance.”

Another of yesterday’s remarkable revelations was that a regulator responsible for improving the quality of healthcare nationally has, in the view of the Permanent Secretary of the Department of Health, a flawed strategy: the management information provided of its own board is solely quantitative, not qualitative. In short, they are simply measuring how many boxes they tick rather than the quality of the work they do. If they cannot get their own strategy and management information right, what authority do they have when telling those they regulate how to do things?

Another disturbing revelation was that senior management, in order to protect their own reputation, changed the regulator’s approach to news management by ensuring information was circulated on a local and regional basis rather than nationally.  This had the effect of playing down problems, when wider circulation of the lessons to be learned could have helped patients in other areas of the country.

Yet another failure was the decision by the Chief Executive of the CQC Cynthia Bowers to scrap the dedicated whistleblower line, previously manned by investigators.  Instead, whistleblowers were put through to a general helpline where we know that calls were missed. One such case led to the Panorama investigation of Winterbourne View where abuse was taking place and CQC ignored more than one call from a whistleblower. We do not know how many other scandals were missed where abuse might still be continuing.

As readers of my blog will know, I have been campaigning for some time for a change in the Department of Health policy as it applies to whistleblowers. At yesterday’s hearing, the Permanent Secretary at the Department of Health, Una O’Brien, agreed to look again at the circulars sent out by her department in 2004 which allows health bodies to sign gagging clauses to silence staff.  She has agreed to send a note to the Committee within the next week and I hope she will take the opportunity to finally change their policy

It was also far from impressive to hear – from the Chief Executive of the CQC – that Parliament had been misled when it was told in the Annual Report that twice as many inspections had been carried out as was in fact the case. The Chief Executive of the CQC suggested that this was a typo. Yet, she was still unable to say when Parliament was informed of the correct information. An error relating to an additional 7,500 inspections is sufficiently large that it is reasonable to expect that it would be spotted. She has said that she will write to clarify the chain of events.

In short, the registration process applied by CQC was flawed. Not a single major investigation was undertaken in the first two years. By contrast, one of their precursor organisations, the Healthcare Commission, undertook 16 major investigations in 5 years identifying significant issues such as the importance of C-difficil. The number of inspections was half the actual number claimed and no prosecutions have been undertaken. The dedicated whistleblower line was scrapped and the news management has sought to play down issues, in order to avoid bad publicity for the NHS. Despite its evident problems, the CQC management underspent against its budget in 2009/10.

For providing leadership to this organisation, Cynthia Bowers is paid £198,000 annually in salary and currently has a pension pot of £1.35m which, bizarrely, has gone up by £421,000 in real terms in the last two years. Ms Bowers suggested this was another typo or error in the Annual Report.

Revealed: How CQC registration is running over budget and has failed dozens of dental practices

From The Pulse

Revealed: How CQC registration is running over budget and has failed dozens of dental practices
By Andrew McNicoll | 20 Jan 2012

Exclusive: More than 30 dental practices and an unknown number of private GP practices have failed to secure registration with the Care Quality Commission, in the first sign that regulation by the new body is prompting some providers to shut down.

The figures for those failing to register, revealed to Pulse under the Freedom of Information Act, come as the regulator also admitted that shifting registration to a new online system will push the total cost £5.5m beyond its initial budget.

The CQC has previously played down fears that its registration process would lead to the closure of providers, publically stating last June that ‘we have not closed down any dental practices’ and reassuring GPs earlier this month that surgeries would not be closed over not having disabled access.

But the regulator disclosed this week that 36 of the country’s 8,232 dental providers have not completed registration, with some subsequently closing. A further 68 dentists have been identified as ‘potentially unregistered providers’ by the CQC and could face prosecution if they are found to continue operating.

The CQC said: ’27 providers have not secured registration with the Commission and have either ceased providing a service or are subject to our unregistered services policy. The remaining nine require specific information to allow their registration to be concluded.’

However the CQC was unable to say how many private GP practices had failed registration because of a ‘temporary technical problem’.
Dr Jack Edmonds, chair of the Independent Doctors Federation and a GP in Harley Street, London, said the IDF had held ‘amicable talks’ with the CQC but warned that the regulator’s inability to provide data on the number of private practices failing registration was symptomatic of a wider issue.

He said: ‘The law requires us doctors to be open, transparent and have evidence that backs up what we tell the CQC. We have to jump through a number of hoops.’ ‘You want us to be transparent? Well, you should be transparent. It is a matter of fairness. The IDF would like to help the CQC if they are having problems – we don’t know if they are as they have not shared any information with us.’

The CQC also revealed for the first time the likely cost of the registration process, which was budgeted at £29.1m. It has spent £25m on registration of all providers so far, and expects to spend a further £3m on NHS GP registration – but also now expects to plough a further £6.5m into IT to support its registration programme that it did not originally budget for.

Dr Peter Swinyard, chair of the Family Doctor Association and a GP in Swindon, expressed concern at the overspend and insisted any additional costs run up by the CQC should not be passed on to GPs.‘The cost of CQC is a very sensitive issue for GPs. To be asked for a lot of money for something with no merit in it for general practice is a big ask.’

A CQC spokesperson said: ‘We are projected to be within budget for initial registration of all providers, with a projected spend of £28 million against a budget of £29.1 million. The additional £6 million is for the development of an online service that will simplify ‘business as usual’ processes for all providers – for example applying to change the status of their registration. GPs will also benefit from this as they will be able to carry out their initial registration online.’

The cost of the CQC
£29.1m – Original CQC budget for registration
£25m – Cost of registering dentists, social care providers, private GPs and others so far
£3m – Estimated cost of registering NHS GPs
£6.5m – Additional unbudgeted cost of shifting ‘registration and regulation’ to an online system.

Bringing premises up to scratch
Hundreds of GP practices sign-up for software to prepare for CQC registration

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