The rotten side of the NHS

Questions are being asked about the way the NHS is run

In an interview on BBC radio, Care Quality Commission chairman David Prior described the allegation that his organisation covered up failings as "shocking".

But perhaps the truly most shocking element of all this is that we are not really that surprised.

The findings laid bare by consultants Grant Thornton on Wednesday confirms something that is becoming clearer and clearer as the months go by: that in the early part of the 21st century a rotten culture developed in the NHS in England that put self-interest ahead of patients.

In short, the NHS stopped caring.

That does not mean that standards dropped in every corner of the NHS. Most services did and still deliver a good standard of care as surveys and reports testify.

But on the occasions where quality does drop to alarming levels the system seems incapable of responding as it should.

This can be seen from not only the handling of the problems at Furness General Hospital where there is evidence of a "deliberate suppression" of failings, but also in what happened with Stafford Hospital.

The public inquiry into that scandal concluded the public had been betrayed by a system that was geared up to protecting itself rather than patients.

But how does this happen?

A natural focus is on individuals. The fall-out from the Stafford scandal has prompted the head of the NHS in England, Sir David Nicholson, to retire.

The old senior leadership team at the CQC - described by Mr Prior as dysfunctional - have already gone.

Chief executive Cynthia Bower resigned in February 2012 and chairman Dame Jo Williams followed in September 2012.

In fact, questions have been asked why Ms Bower was ever appointed.

Like Sir David, she was for a period in charge of the regional health authority that was overseeing Stafford at the height of the problems.

To campaigners and those caught up in the scandals there seems to be a lack of accountability.

The Stafford public inquiry did not call for individuals to go. Sir David only announced his retirement after a media frenzy made it hard for him to do his job.

The Grant Thornton report does not name individuals, even the senior manager who is accused of ordering the destruction of the critical internal report (for the record data protection compliance was given as the reason).

Information sharing

But, of course, it is more complex than that.

There are structural problems. When the CQC was created it took on the responsibility of the three regulators plus a new licensing regime but with a third less funds.

Unsurprisingly, the number of inspections it was carrying out soon started dropping.

What is more, the inspection regime it was told to follow relied on a large amount of self-assessment by trusts.

These were political decisions that had unintended consequences.

But another key factor is the way the NHS works.

When the CQC was assessing Morecambe Bay Trust, which runs the Furness General Hospital, it was not told about a critical review that already existed by either the trust itself or regional health bosses.

The revelation has echoes of what happened with Stafford Hospital when the system failed to share information about the problems that were emerging.

The big question now is whether similar things are happening today.

Both the CQC and government point to changes that are being made.

The views of patients are being given much more weight, whistleblowers are being given more protection and the way hospitals are inspected is being toughened up.

But not everyone is convinced.

Peter Walsh, of the patient group Action Against Medical Accidents, says while it is pleasing the NHS is admitting it has a problem, he is still not sure the systems being put in place are "robust or proactive" enough to deal with problems when they happen.

"I am not confident we have the right systems in place, the regulatory system is still not simple enough."