Is the Success Regime ‘getting away with breaking the law’? (Clue: they’re not!)

They’re not breaking the law … yet.

Yesterday I posted:

Now, I’m not even close to an expert in the law, but I would have thought just as a builder might become liable if someone’s house fell down, the Success Regime’s work will have a long lasting impact on Cumbria’s people, and surely should maintain some accountability for the model design.

They should at least be compelled to carry out ‘suitable and sufficient’ risk assessments of their proposals, in the same way building design has to satisfy safety standards.

They have no intention of risk assessing the options until after the decision has been made. Why?

Because they are only going to use one-in-three of the options. Out of all 12 suggestions, only 4 will be chosen. They’re not breaking the law at all. They only have to assess the risk of the options they decide upon.

Why would they risk assess all the options now when they can wait and risk assess just the four they’ll use?

Here’s why:

The success of the Success Regime hangs on patient safety

Most of the objections by the campaign as a whole and by individual people are concerns about patient safety. They are worried about the roads and the weather, about the time it will take to transfer from one hospital to another, about how much extra pain they and their loved ones may suffer as a result.

They are scared their babies will be born still or with special needs, or on the side of the road in a howling gale and sideways rain. They’re afraid to send their old folks across the county to hospital, because they know patient outcomes are reduced as a result of seeing fewer family and friends in hospital.

And patient outcomes is where it’s at from a health care professional point of view. How well the patient is at the end of the journey is the most important factor to consider throughout the redesign of the health care system. This Royal College of Nursing best practice guide states that clearly. The success of the SR’s redesign will be at least partly measured in healthy, surviving patients.


You’ve got all kinds of road users all the time on Cumbria’s twisty roads. This is part of the A595 north of Cockermouth, the road that will be used most by ambulances and hospital traffic including patients. Image credit to: Graham Robson

So we should all agree that patient safety is the most important thing.

What the Success Regime apparently haven’t realised is that most people will only choose options they perceive as safe. That’s why the campaign has fully rejected all of the options.  None of them are safe, according to local people who live in the area.

So you’d think the Success Regime would clearly show us which option will result in the best patient outcomes and safety. In a full comparison of risks.

If the Success Regime decided to assess ALL the options for risk

a) Their ‘vision’ of Cumbria and how it works would be clearer and easier to understand (and refute misconceptions!)

b) The public could assist with ensuring the right information was in the risk assessment and risk register – a real and meaningful form of consultation and engagement. Revolutionary!

c) It would be much harder for them to argue this model is suitable for rural areas with dispersed populations.

d) The disadvantages caused to poor people, women, children, and older people, would be clearer and more proportionate.

So yet again, the Success Regime miss a trick. They might not be breaking the law, but in refusing to do risk assessments on each of the proposals, they waste an opportunity for real, meaningful consultation. They could have listened to our safety concerns, but instead have boxed off risk as someone else’s job. As if it isn’t integral to the design.

So what can you do about the Success Regime’s awful options?

You might think, okay, we’ll wait till they’ve made the decision and done the risk assessment and as much mitigation as possible, and we’ll cautiously use their services, and then we’ll see if it’s a better experience than before.

But if something really does happen, to you or one of your loved ones, it will probably feel like the health care provider’s fault. You will be urged to make complaints to the provider. In fact, if you take a look at the CQC’s website, they tell you they can’t take your complaints at all; you have to go to the provider, and if you don’t get a result you’re happy with, you can take it afterwards to the Parliamentary and Health Ombudsman.

No-one will be able to say it was the Success Regime’s redesign of the service that caused your loss. Not until lots of people have died or been harmed in a similar way in similar circumstances. After that, a pattern emerges, and it’s easier to see there’s a problem.

Before it can be seen as a design problem, your loss could be put down to individual negligence, under-staffing, under-funding, misconduct, or capability. It could be said to be due to malfunction of equipment. None of which would be the Success Regime’s fault, or the fault of their redesign.

So here’s the thing:

It’s only in testing a design or an experiment that you find its flaws. If you get repeatable results or patterns you didn’t plan, it’s flawed.  But you can’t do that with health care, otherwise you have a lot of dead people and the threat of a public inquiry.

I think, in lieu of being able to test it, the Success Regime should risk assess all its options and make that documentation open to meaningful public consultation.

What do you think?

Comment below and let me know!

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3 Responses to Is the Success Regime ‘getting away with breaking the law’? (Clue: they’re not!)

  1. Margaret Bowe says:

    Why spend 90 million on a new NHS Hospital and not use the facilities.It’s ridiculously stupid to have everything we need and then spend our budget on transporting patients and thier NHS money to Carlisle to help a private firm get out of debt .Carlisle cannot cope with its own patients as it’s too small .Heart patients are given stent etc in portacabins.So why cant the consultant not travel to West as they have done for years as they get paid for every person they treat .Our budget has been robbed by Mr Rushmore who transferred patients to Cramlington they made 5 million from us .Now Carlisle want our money to build an extension and we are the ones left to feud for ourselves

  2. Geoff Hurst says:

    Firstly Carlisle hospital isn’t a private firm, the hospital was built with PFI. but that’s a whole different argument.
    The success regime will be the architects of the planed changes and as such are responsible for the outcome should it succeed or fail.
    If as your comparison with the builder and the house, if the builder builds your house and it falls down, but he has built it in accordance to the plan the architect has supplied, it would be the architect who would be at fault and not the builder.
    There are hundreds of different designs of houses and regulations the architect has to take into consideration when submitting the plan.
    The success regime has only 4 and most of the consideration would generic and could apply to all 4 plans.
    In my opinion (I don’t like calling them success regime cause I can’t think of any successes they have had up to now) they are the architects of the plan and they are ultimately responsible

    • Hi Geoff, I believe you are right, certainly in principle. In the limited experience I have had with the building design process, when an architect or building designer creates their designs, they reference safety issues as they go, and amend the design as appropriate, so as not to waste time or efficiency. The Success Regime has no such need.
      And I agree that calling them the Success Regime is annoying – in fact ‘Success Regimes’ and ‘Failure Regimes’ are corporate ‘change management’ concepts that have been adopted by the NHS England management, perhaps because they allow even more use of private consulting firms like Freshwater and The Campaign Company, therefore syphoning off even more taxpayers money from the ‘failing’ NHS.

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