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Lessons from the banks for CCGs

http://www.pulsetoday.co.uk/practical-commissioningl

The biggest problem with the banking industry is not greed. It's only natural for greedy people to gather where the money is. Nor is it lack of regulation, because there are regulations and laws aplenty. It's the failure to punish wrongdoers that makes people a bit cross. 

A few bankers go to jail each year for individual criminal acts of insider trading and false accounting. Institutional greed and carelessness, such as the sub-prime mortgage scandal which triggered the 2008 crash and plunged the world into recession, are seldom punished.  

Knowing you will probably get away with it is a powerful incentive to criminals and a charter for incompetent managers.

There are unmistakeable parallels with the NHS. Individual cases of professional misconduct – a callous nurse or molesting doctor – make salacious headlines, but the leaders of institutions providing substandard care to thousands of people, or wasting millions of pounds of public money, get off without so much as a caution. 

Failed chief executives are never really sacked, merely recycled. Failed institutions are bailed out even when it is clear they should be shut down. 

In no other industry, except banking, would you see insolvent organisations rescued as a matter of course. NHS trusts are too important to fail, so we allow them to fail repeatedly. The effect on the successful organisations which subsidise the serial failures is to drain them of resources and of the will to keep succeeding.

The get out of jail free card for failing institutions is that the innocent will suffer if they're not rescued. It's the NHS, stupid. 

Will patients really die if a collapsing hospital trust is not shored up with piles of cash?  Or will they die out of sight somewhere else where better care might have been provided to more people with the same resources?

That is why the news about South London Healthcare Trust, to which Andrew Lansley last week appointed an administrator because of its continuing debt problems, is so important. The secretary of state has unleashed the bull he wants CCGs to take by the horns.

So far, so bold. 

We don't do so well when it comes to the bit about light-touch regulation. It's hard to work out who's in charge in a landscape filled with partners, collaborators, networks, and boards. Deeper and thicker mud for regulators to wade through.

Strong enforcement and clear regulation are mutually dependant. You can't have one without the other. Punishing the guilty is only possible if you know who they are and they know what they are responsible for.  Who leads the NHS? The secretary of state, the NHS Commissioning Board, CCGs, health and wellbeing boards? If they all do then none of them does. 

Greedy bankers inspire tent pitching and placard waving, but there are no such energetic calls for social justice when residents in a care home are abused by staff or when people living in one part of the country die a decade earlier than people ten miles away.  

The report on Winterbourne View is just the latest excuse for an investigation to draw all the usual conclusions. Everyone meant well and tried hard, but things went wrong. We'll try not to do it again. A few people are due in court to answer individual charges of brutality. Nobody responsible for the systematic failure at Winterbourne and places like it will get anywhere near a courtroom, let alone a jail.

Even Stephen Hester, chief executive of RBS, whose computers have gone down so inconveniently, can do better than that. He has been very clear about who is responsible and what is to be done about it. Branches will stay open until it's sorted – and if sorting it takes too long, no doubt he'll fall on his sword. 

The RBS affair paled into significance beside the news of the rate-fixing scandal which looks certain to lead to reform of the banking system. The news wiped £3bn off the share value of Barclays, the bank at the centre of the storm, and cost its boss, Bob Diamond, his job.

In both cases, expect the pain of sudden unemployment and disgrace to be alleviated by a large severance package. Nevertheless, those responsible will have been punished - after a fashion.

The NHS may not be ready to lead the world in accountability, but it's a sorry state of affairs if we can't be better at it than the banks.

 Julian Patterson is director of development for NHS Networks www.networks.nhs.uk

This article first appeared on the blog section of their website.

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