Who inspects the inspectors?
Late in the evening of 6 July 1988, the Piper Alpha oil platform 110 miles north-east of Aberdeen was destroyed by two big explosions; 167 men were killed. The Cullen Inquiry found that the platform had been inspected 12 days before the disaster to check on progress following a fatal accident nine months before. The inspector had spent ten hours on the platform and concluded that ‘lessons appear to have been learned’. Lord Cullen was not impressed: 'the inspection... was superficial to the point of being little use as a test of safety on the platform. It did not reveal any one of a number of clear-cut and readily ascertainable deficiencies.’
Recent events surrounding the Care Quality Commission and the University Hospitals of Morecambe Bay NHS Foundation Trust seem little different in principle. Whatever transpires regarding the alleged cover-ups, there is agreement that the CQC should have done better as an inspectorate.
But it's hardly surprising that it didn't. The CQC was established in 2009 by merging the Healthcare Commission, the Commission for Social Care Inspection and the Mental Health Act Commission. At the time of the merger they had a combined budget of £240 million. By 2010-11 the CQC budget had fallen to £161.2 million, and it had the added duty of registering all health and social care providers (including dentists and private ambulance services).
My first job was testing urine, sputum and other specimens in the laboratory of a Lancaster hospital, in the Morecambe Bay catchment area. Now closed, with its buildings turned into expensive flats, it used to be called the County Lunatic Asylum. In the 1840s, its medical superintendent was Samuel Gaskell (Elizabeth Gaskell’s brother-in-law). He removed the wrist and leg-lock restraints and paid particular attention to making life better for the incontinent. When he was later made a mental health commissioner, he was the model inspector. He tasted hospital food, rummaged round the privies, inspected the beds and looked into cupboards. Casebooks were read, patients interviewed and mortality rates investigated. Hospitals were inspected annually. And reports were published on time.
Acute hospitals now are absolutely different from those of Gaskell’s time. The complexity of their activities is orders of magnitude greater. They cure. But Gaskell would be familiar with the misfortunes suffered by patients at Winterbourne View and Mid-Staffordshire.