Patients left at risk by health quango’s focus on red tape

Patients have been left at risk as the country’s main health watchdog quango carried out 70 per cent fewer inspections in order to focus on bureaucracy MPs find.The Care Quality Commission was guilty of a “significant distortion” in its priorities as it concentrated on red tape rather than checking that hospitals and care homes were safe, according to the Health Select Committee.

The situation was made worse by the fact that almost 300 posts were unfilled at the regulator and it failed to make Government understand the difficulties it was facing in adding dentists to the professions it monitors.

A damning report accuses the CQC of responding “woefully” to a whistleblower who uncovered abuse of people with learning disabilities at a private hospital, and of only offering “out of date and unhelpful” information to the public.

The MPs also call on the watchdog to focus on the broader culture at hospitals and care homes, rather than individual failings in treatment, to make sure that complaints are not being suppressed.

Stephen Dorrell, the Health Secretary under John Major who now chairs the select committee, said: “In its review of the CQC, the Committee concluded that the organisation’s priorities became distorted by a statutory deadline for the registration of dentists and that this distortion led directly to a drop of 70 per cent in inspection activity during the second half of 2010-11 compared with the same period in the previous year.

“The primary causes of this distortion, which resulted in increased risk to patients, were the unrealistic statutory obligations imposed on the CQC.”

Rosie Cooper, a Labour member of the committee, said: “I was really disappointed that the CQC allowed itself to get trapped in the regulatory profess and that restricted its ability to carry out inspections, which left vulnerable people at risk.”

The CQC, which has a budget of more than £160 million, was formed in 2009 in a merger of three separate watchdogs for healthcare, mental health and social care, and set about registering thousands of NHS hospitals and care homes.

But it missed its target of registering 8,000 dentists by April because of its complex process and the deadline for putting GP practices on its books has been postponed for a year so it can catch up.

As a result of this focus on administration, the select committee says that CQC inspections to see if patients are being looked after safely fell by 70 per cent, from 6,840 between October 2009 and March 2010 to 2,008 in the following six months.

Meanwhile its number of job vacancies rose from 148 in June 2010 to 297 a year later, “a further cause for concern”, almost half of whom were the inspectors and registration assessors it needed the most.

The MPs said the watchdog should have argued its case to Government more persuasively and far sooner.

Caseloads for the CQC’s inspectors have risen from 50 to 62 organisations over the past year, and so many assessments are mere “box-ticking” exercises carried out from its offices.

After a nurse contacted the CQC to complain about abuse at Winterbourne View, its response was “woefully inadequate”. Calls from whistleblowers elsewhere increased after the scandal was exposed by Panorama but this could be “only the tip of the iceberg”.

The CQC has a website where patients and relatives can read reports on hospitals and care homes but in many cases they are “several years old” and contain “limited” information.

Smoking in the mornings increases cancer risk

Smoking soon after getting up in the morning is more likely to increase the risk of cancer than those who light up later in the day.
A study of 7,610 smokers, published in the journal Cancer, said the effect was independent of other smoking habits.

Smoking in the first 30 minutes after waking nearly doubled the, already high, risk of lung cancer.

Cancer Research UK suggested people who were quick to smoke may inhale more smoke into the lungs.

Scientists at the Penn State College of Medicine in the US looked at 4,776 smokers with lung cancer and 2,835 smokers without cancer.

They showed that patients who smoked in the first 30 minutes after waking up were 79% more likely to have developed cancer than those who waited at least an hour.

The researchers said that the “time to first cigarette” effect was present even after they statistically adjusted for other factors such as the number of cigarettes smoked in a day.

Another study in the same journal looked at 1,850 smokers, 1,055 of whom had head and neck cancers. It said people who smoked in the first half hour were 59% more likely to have developed a tumour than those who waited at least an hour.

The authors admit: “It is uncertain what explanation there is for the relationship”.

Dr Joshua Muscar, lead researcher, said: “These smokers have higher levels of nicotine and possibly other tobacco toxins in their body, and they may be more addicted than smokers who refrain from smoking for a half hour or more.”

Cancer Research UK’s Professor Robert West said: “Smokers who light up soon after waking tend to smoke each cigarette more intensively.

“So the most likely explanation of this finding is that the sooner a smoker lights up, the more smoke is taken into the lungs, and the higher the level of exposure to cancer causing chemicals.

“This may help estimating levels of tobacco exposure more than just looking at the usual daily cigarette consumption.”

St John Ambulance abandoning volunteers over restructuring

St John Ambulance, the charity, has been accused of abandoning its volunteers as it attempts a widespread restructuring project.The first aid organisation has announced plans to streamline its management amid financial woes.

It is set to embark on a major restructuring exercise to rebalance its books, which includes setting up eight regional boards and merging offices in 41 regions.

But the charity, which has recorded operating losses seven years in a row, is accused of “kicking volunteers in the teeth” by those who regularly help out.

They claim that disillusioned volunteers will no longer want to raise money if the cash goes in a central pot rather than helping local projects.

“All counties work in their own particular way according to their local people and in a way that can only be done by them,” one senior volunteer said.

“If the structure is changed … what incentive is there for local people to volunteer and raise money?”

A former chairman of a county division claimed the changes would lead to “financial ruin”.

“We are absolutely horrified because we feel that this restructure is doing away with the strong volunteer ethos of St John’s. It’s like kicking volunteers in the teeth” she said.

Under the plans eight regional directors will be created on salaries of £80,000 a year plus benefits to represent London, the south east, south west, East Midlands, West Midlands, East of England, North-West and North East.

Officials admitted that “financial” pressures were partly behind the new structure as well as “increasing regulation”. It denied it was in “imminent financial crisis”.

While the service claimed there would be no redundancies the charity admitted “some roles have been placed at risk and are therefore undergoing consultation”. It would not provide further details.

The charity, founded in 1877, currently employs about 1600 staff across the country and has more than 40,000 volunteers on its books.

It trains more than half a million people a year and has more than 1000 ambulances that provide support to NHS trusts. The Duke of Gloucester is the service’s Grand Prior of the Order.

In a letter sent to volunteers around the country, Rodney Green, the charity’s Prior and chairman of board of trustees, admitted the organisation faced a “number of difficult challenges in the years ahead”.

A briefing note sent to volunteers explaining the changes, said the organisation needed to increase its “charitable and community impact”.

“We need a greater consistency in our quality – so that we can meet more stringent regulatory requirements and also better support the front line,” stated the document, titled “Becoming ‘The Difference’: transforming St John Ambulance”.

“More urgently, we need to balance the books and achieve secure finances.  For seven years running, we have spent more than we earned and are set to make further losses this year. The charity cannot sustain this.”

Mr Green insisted the changes, signed off by the trustees last month following “rigorous analysis of the current structure”, would transform the organisation “so that we can save yet more lives”.