Maddening TLAs

By | 1st March 2010

Care Quality CommissionThere are 3 things the NHS loves – bureaucracy, TLAs and controlling doctors, particularly GPs.

This may sound paranoid and it probably is, but just because you’re paranoid it doesn’t mean the government isn’t plotting to undermine general practice!

If you don’t work in the NHS you’ll probably be wandering what a TLA is – and there we have it, two Three Letter Acronyms in one sentence.

The NHS is arguably the biggest TLA in the world and the UK government may be the largest creator of TLAs. I suspect this is because it isn’t our political masters who really run the NHS but those Whitehall Mandarins who control their political masters. So it doesn’t matter which party is in power, their tinkering in the NHS will continue and TLAs will continue to abound.

Cause for Concern

The latest TLA to be a CFC (Cause For Concern) is the CQC or Care QuaIity Commission. Regular readers will know of my cynicism of bureaucratic titles, which hide their inadequacies – in effect the opposite of the Ronseal promise – what you get on the label is most definitely not what is inside the tin.

First of all CQC does not commission anything, it is a regulatory body. Their website is interesting and appears to give a robust assessment of a variety of public and private providers of care – enabling the public to choose between zero to three star institutions. This all seems excellent and laudable because its goal is to drive up standards of care. But that starts to ring alarm bells in my mind – because similar to exam results for the last 20 years standards appear to be going up all the time, but my experience tells me that just as medical students are definitely not higher calibre now than they were 20 years ago, patients are also not getting a better service.

Wonderful care

When I first moved to Bournemouth in the early 1990s there were a number of excellent small rest homes who provided wonderful care – they treated all their residents as though they were family. None of these small rest homes have survived successive government measures to improve care! So often when we intervene good intentions we achieve the opposite of what was intended.

When you dig deeper into the CQC it is apparent that Quality Care is about following government guidance! So Care = adhering to guidance and Quality = government opinion. Oops, once again we have the Anti-Ronseal promise. Alas the CQC will soon be turning their attention on General Practice. It won’t be long before you are able to compare all local practices close to your post code. Pity those poor practices who are zero rated by the CQC simply because they have a different priority than the government about what is quality – it is possible to achieve a lower rating and still offer exceptional care.

Zero rated

This might sound like sour grapes or a pre-emptive strike by our practice because we will be a zero rated practice. If you think that’s the case then please Google GP patient survey and then compare our results with any other practice in the UK. So even though we may end up with a positive rating from the CQC, I still fear its inference.

Effectively all these organisations which seek to rate or quantify care or education or any of the other social sciences, will always miss the point. These areas of life are simply too complex to distill down to a star rating. It is with a great sadness that hospitals are rated on a variety of different measures but none of them even come close to capturing the comfort and care given by a nurse who has the opportunity to sit on the side of a bed and chat to a patient.

We have trimmed so much off the NHS that the fat has long gone and were now shaving off bits of heart. There will come a time when the bureaucrats will kill off our NHS without even realising that they’ve dealt it a fatal blow.

Perhaps TLA means The Last Action?

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