21 March 2009

For the Royal Cornwall Hospitals NHS Trust (RCHT) life must seem one damning thing after another, report after report after report. Patients and workers at the RCHT are by now surely both distressed by the criticisms and immune to them.

I gave up posting about it – too depressing, inde ira et lacrimae. I don’t see the point of a system which secures reports on difficulties but apparently does nothing with effect to ensure they are put right.

Now another report criticises the trust. It’s here, dated 25 February 2009 and published 20 March 2009.

A lot of the report is recounting recent history but it also suggests twenty seven changes. The report focuses intentionally on administration not the medical work, though it notes RCHT healthcare reported difficulties, and it can be summed up in one key sentence:

“It is the opinion of this review that, on balance, whilst there are examples of good management from the exploration of the trust’s history during 2007 and 2008 neither the trust boards throughout the period nor the chief executive have achieved the overall standards of management and governance expected of a public service organisation like the Royal Cornwall Hospitals NHS Trust…” (paragraph 98).

That’s clear and supported by a detailed account of their weaknesses and failings.

The concluding paragraph 103 of the report is especially damning:

“…the direction of travel of the leadership and management of the Royal Cornwall Hospitals NHS Trust is towards corporate failure.”

Will anything with effect happen? Well, it would be unprecedented if it did. More likely we shall be given a handful of ritual goings and be drowned in much talk of a clear break and a new start and new initiatives and light at the end of the tunnel or whatever the modish cliches are for these occasions. Then we shall wait, wearily, cynically, for the next report, as we have in the past; and as we have in different circumstances of failure for the disappearing Cornwall county council.

It cannot be impossible to improve the RCHT, to end the sequence of Galatian failings and damnations, to coax or drag it into the sun.

However, I do think the £46 million loan from the Department of health is a difficulty. I can see that the government do not wish to be seen writing off, with our money, the incompetences and failings of organisations: that course does not encourage striving for competence and could be seen as rewarding failure. But who gets punished here? Can the RCHT pay off the debt without damaging services for patients? I don’t know but I doubt it. We should be shown any detailed plan to do this; and the board, the regional NHS authority (the Strategic Health Authority), the primary care trust, and the government should tell us bluntly whether we have to pay for these errors with a lesser service.


inde ira et lacrimae (thus the anger and the tears): Juvenal Satire I.168

A repetition of repetitions: DH Lawrence (1921), Ursula musing in Women in love, chapter 15, though the context in the novel is irrelevant here

Galatian failings: see Robert Browning (1842) Soliloquy of the Spanish cloister, stanza 7

Previous posts
Good news about St Michael’s hospital in Hayle, part of the RCHT. Look at the entry for 17 January 2009.

Hinc illae lacrimae 17 October 2008

Unglowing health care in Cornwall 18 October 2007

The review is the Independent review of management and governance at the Royal Cornwall Hospitals NHS Trust by David FIELDING, Neil GOODWIN, Ruth HAWKER, and David STOUT