Cynthia Bower and her two fellow directors of the Care & Quality Commission (CQC) certainly deserve to be punished for their infamous offence of suppressing an internal report about the deaths of babies in hospitals they were responsible for, in order to protect their own skins. But horrifying though this revelation is, the real problem does not concern personalities but rather structure and ideology.
Morecambe Bay is the canary in the mine providing a warning about what is going to happen far more widely across the NHS in the next few months and years. The central issue is the intense pressure being put on managers and regulators under the new market-based system to cover up when things go wrong because otherwise the precipitate haste to rush to foundation status, the hallmark of marketisation of the NHS, will be derailed.
Foundation status paves the way to privatisation as the next step. It provides the opportunity to generate half their income from private patients, and half their beds and staff can be deployed for that purpose. They can undertake joint vantures with corporations and private shareholders, and can sell land and buildings and, if they choose, lease them back. In effect they are the half-way house packaging up the NHS for private investors and the big (mainly US) health corporations.
Against that background there were two factors that set up the Morecambe Bay tragedy. One is the foundation trust conveyor belt put in place by the Health & Social Care Act 2012 that lays down that most NHS hospitals must be authorised as foundation trusts by 2014 whilst at the same time phasing out NHS trusts. The other is the grossly over-extended range of burdensome responsibilities placed on CQC which was required, inter alia, to register 378 NHS trust by April 2010 because registration was a necessary component of market authorisation for foundation status provided by Monitor, the economic regulator.
The CQC was massively over-loaded with functions it couldn’t conceivably fulfil within its severely depleted resources, and it was staffed at top level by managers unwilling to take on the politicians by making public their impossible task. Morecambe Bay on its side is crippled by a huge deficit of £16m and under the relentless market-based system has no alternative but to make large and ever larger cuts which compromise its quality of care. The real tragedy behind the CQC/Morecambe saga is that market-driven changes have generated deficits and poor quality care from which hospitals cannot escape (they will be closed down, irrespective of patient need) and which managers are forced to try to conceal.
