An Inadequate and Outstanding Hospital

Rupert Beale

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.


  • 23 September 2015 at 1:09pm
    Paul Taylor says:
    American academics write that 'an EPIC hospital system, such as that at Addenbrookes, costs from US$250 million to US$1.1 billion, where implementation accounts for two-thirds to three-fifths of the total'(1). Interestingly Addenbrookes, according to Computer Weekly, paid only £40 million to EPIC but will have incurred additional costs, since a proportion of the IT staff working on it will be paid by the hospital.

    The CQC report mentions EPIC 115 times. THere are plenty of positive comments about how the system has helped with improvements, as well as numerous negatives. Some of those relate to what might be described as teething problems, and realistically an element of that has to be expected when changing something as fundamental to the administration of an organisation. But there are also some significant problems identified.

    Some would argue that these systems are based on very old-fashioned approach technology. One element of which is that, which won't concern the CQC, is that the supplier's business model relies on controlling the data, making it hard for the customer to move to a different vendor. A great many hospitals are locking themselves into contracts which effectively ensure that patient data is only accessible either a) in a pre-defined way or b) for a fee. It seems mad to those of us who work with patient data for research.


    • 24 September 2015 at 7:39pm
      Sean Whitton says: @ Paul Taylor
      A link that will work for those of us who are not students or academics at UCL:

  • 23 September 2015 at 8:14pm
    streetsj says:
    Dr (?) Beale, you don't get it do you. If your hospital was a profit making business your success would be admirable: curing patients, increasing demand, ensuring repeat custom; but it isn't. It's a free public service and all you and your colleagues are doing is making the problem worse. A successful NHS hospital would offer poor service, reducing future demand and even killing a few patients pour discourage les autres.
    Doctor, your way bankruptcy lies. I'm not sure special measures will be enough - you need a whole re-think.