East Kent is a test case for new CQC regime and its consequences

How do we square the fact East Kent Hospitals had the highest possible Monitor rating for governance with its damning Care Quality Commission report? The latter focused on the “worrying disconnect” between the trust’s management and its staff and the evident unhappiness of its former lead governor.

‘It is significant the regulator is yet to decide what action to take despite knowing about the CQC’s concerns for some time’

The likely answer is that this is the first example of the CQC’s more robust approach to inspection revealing a deep seated cultural problem missed by previous lighter touch scrutiny. The CQC’s new inspection regime was highly influenced by its failure to identify the problems at University Hospitals of Morecambe Bay Foundation Trust – a failure that led to Monitor not paying close enough attention to what has proved to be a trust shot through with weaknesses.

Monitor’s ire at the egg on its face gave further impetus to the CQC’s plans for inspection reform.

East Kent’s CQC report was a surprise to many, particularly that the problems had been “inherent for many years”. Along with the warning from chief inspector of hospitals Sir Mike Richards that some trusts are “in denial” about their difficulties, this will have sent a shiver of apprehension down the spines of those awaiting the inspector’s call.

A complex case

But there is another narrative running that highlights the tension between the new tough line on inspection and the challenges facing the service.

‘Placing East Kent into special measures would create a real headache for Monitor’

Placing East Kent into special measures would create a real headache for Monitor. It is significant the regulator is yet to decide what action to take despite knowing about the CQC’s concerns for some time.

The report took five months to publish, rather than the normal two. As has happened with other inspection reports delivered under the new regime, there was disagreement between the trust and the commission over its content.

The trust does not seem to have been very successful in mitigating the criticism. However, Monitor will be aware this is not an open and shut case – and that local politicians have been vociferous in their support for trusts. The MP for Thanet North, Sir Roger Gale, called the report “disproportionate and irresponsible”.

Lessons from Medway

Monitor may have learned from the nearby example of Medway Foundation Trust about the risk of a trust’s leadership being gutted. While what took place there was considered warranted at the time, the FT has seen upheaval and controversy, and little service improvement.

Attempts to replace senior executives with top flight recruits have been hampered by politics and the trust’s deteriorating reputation.

Compared to Medway, Monitor must have considered East Kent a safer bet, with chief executive Stuart Bain having led a stable leadership since 2007. He will be leaving due to ill health and the finance director is going to another trust, so rebuilding will be necessary. But Monitor will not want a repeat of Medway.

New kind of stewardship

East Kent had also appeared to be a financially sound trust. However, the report said staff felt it was run as a “business” rather than for the benefit of patients and the CQC claimed there was a “financial driver” for poor staffing levels and a lack of equipment.

‘East Kent’s future will prove an important test case’

The trust has a £27m savings plan for 2014-15; it would only take a relatively small adjustment to tackle some of the problems identified in the report for East Kent to join the increasing number of acute organisations predicting a serious deterioration in its finances this year. Monitor will proceed with caution.

East Kent’s future will prove an important test case. Monitor, or indeed the NHS Trust Development Authority, will want the CQC to surface serious quality concerns when they find them. But the actions the stewards of the provider sector take as a consequence will increasingly be coloured by the implications for an organisation’s finances and leadership.