The discovery at Basildon and Thurrock University Hospitals of blood-spattered floors, half the privacy curtains soiled, commodes soiled under the seat, and mattresses stained through to the foam has sent shock waves through the whole regulatory ststem. When the hospital trust was rated ‘good’ on quality of service by the Care Quality Commission (CQC) in their 2008-9 assessment, ‘excellent’ for financial management and scoring 13 out of 14 for cleanliness, 7out of 8 for care, and full marks for keeping patients healthy, yet the death rate was almost 50% above the natural average and blood splatter, dirt and staining were found to be widespread, confidence in the regulatory system collapses. But what makes this so significant is that this is not an isolated example. Earlier this year similarly poor standards were found at Mid-Staffordshire NHS foundation trust and it was estimated that some 400 deaths had occurred there needlessly over 3 years because of healthcare failures. Every time the authorities assure us that lessons have been learned and that these failings will never happen again. And then they do.

The real culprit in this saga is that regulation is suppoed to square market ethics with accountability, but in the nature of the case it can’t. Health provision under a public service ethos focuses on quality of care, professionalism, vocational commitment, and co-operative teamwork. Health provision driven by the market concentrates on cost-cutting, efficiency savings, transactional accounting and final profit goals. The idea that the latter system driven by such objectives can be reconciled to the highest standards of health care merely by regulatory inspection is patently flawed. High quality care is certainly desired, but it is a second-level variable, not the central driver of the system.
Recent experience has shown the same tensions and the same flawed consequences in several other sectors. The Nimrod crash that killed 14 airmen in Afghanistan in September 2006 was shown conclusively in the official report to have flowed from emphasising cost-cutting over proper safety measures which were neglected or minimised. The Clapham rail crash that killed 35 passengers in 2001 was found to be due to faulty electrical work caused by excessively long shift-working. The rise in deaths on construction sites to over 60 in the year 2000 resulted from the neglect of basic health and safety measures in a cowboy industry driven quick profits. The alarming rise in MRSA deaths, especially at the Maidstone Hospital in 2002, was shown to flow from competitive tendering in cleaning services where externally hired, less committed cleaners did not have the same dedication to the quality of their work as better tained in-house cleaners.
Regulation, however good – and it is sometimes little better than box-ticking – can never substitute for wholehearted commitment to the public service ideal, and the consequences of the inevitable eventual breakdown in the regulatory system does not even make it cost-efficient.

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