John Crown (Independent)
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Indeed. Democracy really is in action here. I thank the witnesses for appearing here today. I know a little about this area. As well as being involved in medicine, I studied health care quality formally at masters degree level in an MBA programme. What struck me about the formal study of quality is that it has little to do with quality and everything to do compliance, that is, compliance to a predetermined standard which is set at an arbitrary level of performance, against which those whose quality is being assessed can be measured. Unfortunately, these predetermined standards almost never include the actual outcome of the health care itself. That is why the society which has the most intensely regulated health system, the one which in many cases has acted as the poster child for HIQA-like model, namely, the United Kingdom's National Health Service, has such poor outcomes. Figures which have just been released by the OECD from a survey of cancer survival rates show yet again what everybody in this business knows, that is, if a system is desperately short of doctors, nurses and resources in general, the thing which will fix poor outcomes is not building another bureaucracy and throwing it at the problem. That is what the British have done and what we have done with the development of HIQA.

To me, the idea of having appropriate regulation is critically important and perhaps HIQA, in some other parallel universe, could provide it. However, the extraordinary disproportion between the focus of HIQA on process in individual hospitals, together with its complete and systematic neglect of the big picture, which is the bizarre nature and structure of our health system and the bizarre under-staffing levels we have, was perhaps best exemplified in the Savita Halappanavar report, which was very inadequate. I will not use any specifically derogatory term but it absolutely skirted around the key issue, which was not that there were poor processes in place but that a tiny number of trained people, in the most medically under-served part of the most medically under-served country in western Europe, in terms of the number of specialists per head of population, were asked to do a job that would have been done by six, eight or ten people in another, more normal, environment.

In truth, if at some stage we fix the health system, making the appropriate investment in it and reorganising its structure so that it behaves in a rational fashion, we will need regulation. We are putting the cart before the horse right now. What is happening - and I shuddered a little when I heard the description of how HIQA's regulatory tentacles are going to spread into every other aspect of health care - is that HIQA is in danger of becoming the armed wing of the HSE. That is what it looks like from my perspective and that worries me. I am very worried about one particular issue. In recent months I have become aware of mission creep with respect to the regulation of clinical trials, where HIQA is going way past regulation and will be managing those trials. HIQA is going to be setting up-----