An Inadequate and Outstanding Hospital
In Yes Minister, 'one of the best run hospitals in the country' turns out to have a major advantage: it has no patients. This week, the Care Quality Commission said that the hospital I work at, Addenbrooke's in Cambridge, is 'inadequate', despite acknowledging that the care provided to patients is 'outstanding', with one of the lowest standardised mortality rates in the UK. This outstanding hospital is so inadequate that it's been placed in what are euphemistically termed 'special measures'.
There are some real problems: the CQC report highlights a shortage of nursing staff and a lack of ward capacity, long waiting times for outpatient appointments, and an expensive, clumsy IT system. But the healthcare delivered is agreed to be excellent, and isn't the point of a hospital to deliver healthcare?
The popular chief executive has resigned, just before the report would have made his position untenable. Since April, when the inspection took place, many of the problems have been addressed; in particular, a recruitment drive has improved the staff shortages mentioned in the report. The people responsible for implementing the special measures will be able to claim a rapid success. Even dedicated NHS staff don't work entirely for free though, and the trust is losing more than a million pounds a week.
The problems – by no means unique to Cambridge – are good problems to have: better treatments for more conditions and an increase in life expectancy. Of course we could be more efficient, especially if our IT systems worked properly. IT for the NHS has been developed not necessarily to our advantage, usually because we underinvest in it. Worse, the new proposals for junior doctors amount to a very foolish underinvestment in our most important staff. However much we might wish it otherwise, you can't deliver a higher standard of care without spending more money.