The Week, 21 October 2022
The weekend papers will be wall-to-wall with speculation about who will replace Liz Truss as PM — yet more political chaos distracting from the deep, and worsening, crises facing the country. As ever, our eyes have been on the latter, and we have the policy highlights (or lowlights) you may have missed.
A report by the Health and Social Care Committee this week confirmed what the public sense: general practice is “in crisis”. The parliamentarians do not mince their words. Despite more appointments being completed now than before the pandemic, by fewer staff, the report cites “unacceptably poor access” (with sometimes half of patients struggling to secure an appointment) and declining patient experience (72.4% rate their overall experience as “good”, compared with 81.8% in 2020). Meanwhile, although GP recruitment has increased, it suggests a lack of professional morale means that they “are leaving almost as fast as they can be recruited” — resulting in “high reliance” on the use of more expensive locum doctors.
The report is right to recognise that retention issues go beyond pay. Crucially, making sure the best people want to continue working in primary care is also about organisational culture, working conditions, and autonomy. The report contains an interesting recommendation in this regard, calling for the abolition of the Quality and Outcomes Framework (QOF) and the Impact and Investment Framework (IIF). Setting targets can help drive competition, track performance, and create expectations around minimum standards of care, but there is a trade-off to be made. Too much micromanagement — and nationally set, incentivised targets — comes at the cost of clinicians being able to exercise judgement, and focus on providing the best possible care.
Also published this week is the independent Kirkup report, recounting the appalling failure of maternity and neonatal services in East Kent. After an investigation of hospitals in Margate and Ashford, the report finds that between 2009 and 2020, those responsible for services “too often provided clinical care that led to significant harm” and “failed to listen to families”, meaning that outcomes could have been different in 45 of the 65 baby deaths assessed by the panel.
The deep human tragedy in East Kent is at odds with the Trust’s mindset, which was “too often to be defensive and minimise problems” and to not listen to families when they raised the alarm bell. The report cites professional “cliques” that would exclude more junior members of staff, creating “hostile” in and out group dynamics, damage team working, and mean that new staff were “given challenging cases and expected to manage them without support”. The report is, quite simply, a horrific read — and all the more so as, rather than being an awful but anomolous case, Kirkup is clear that this is “simply the latest” in a long list of investigations into failing NHS Trusts, “going back as far as the 1960s”.
The Care Quality Commission’s ‘State of Care’ report, out today, is also highly critical of maternity care: “The quality of maternity care is not good enough. Action to ensure all women have access to safe, effective and truly personalised maternity care has not been sufficiently prioritised to reduce risk and help prevent tragedies from occurring.” In other words, the Service isn’t learning and then acting on that learning.
This should be the focus of Members of Parliament.
Onto the reads…
Our first recommended read is the interim report from the Casey Review, which is looking at misconduct in the Met. It finds that internal misconduct cases (except those referred to the IOPC) take an average of 350 days from complaint to sanction in the Met, with 57% resulting in 'no case to answer' in 2021 — 11% more than across England and Wales. But most concerning is the finding that patterns of misconduct are not tackled robustly, meaning that "repeated or escalating misconduct is not spotted" and the Met is "missing those who potentially pose the most risk to others." Given that Sarah Everard was murdered by an officer with a history of such allegations, this is an especially significant failing from the Met.
Our next recommended read is a report by the Work Foundation, which draws on its previously developed “Insecure Work Index” and finds that over a quarter of women (26%) are in insecure work, compared to 14% of men. Furthermore, this finding holds at all levels of the professional hierarchy — with senior women twice as likely to experience “severely insecure work” as men. A key reason for this, the report argues, is that women have a greater preference for flexibility, which increases insecurity. Far from treating this as an inevitable trade-off, the report recommends increasing flexible work for everyone, and increasing provision of affordable childcare, to reduce the specific barriers faced by working mothers.