Hospital inspections to be more robust, chief inspector says


Prof Sir Mike Richards: "We are taking on where Sir Bruce Keogh's report left off"

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The way hospital inspections in England have been carried out was flawed and they are to become broader and more robust, the new chief inspector says.

Prof Sir Mike Richards said the system used by the Care Quality Commission (CQC) had been too narrow in focus.

He wants to recruit a "small army" of doctors, nurses, patients and carers to carry out inspections and ratings.

It comes as 11 trusts have been put into special measures after previously unidentified failings were uncovered.

The move was announced on Tuesday after the publication of an independent review led by NHS medical director Sir Bruce Keogh.

An investigation into 14 hospital trusts was launched earlier this year following the public inquiry into the Stafford Hospital scandal, which said the public had been betrayed by a system which put "corporate self-interest" ahead of patients.

The trusts were identified as they had the highest death rates in 2010-11 and 2011-12.

The probe focused on whether the figures indicated sustained failings in the quality of care and treatment at the trusts.

Only two of the 11 trusts that ended up in special measures had been facing sanctions from the CQC.

'Fair and transparent'

Setting out his plans, Sir Mike, who formally took up his post this week, said it would be a "completely different way of inspecting hospitals".

Start Quote

Every finding will be made public”

End Quote Prof Sir Mike Richards Chief Inspector of Hospitals

Admitting it would be a "huge challenge", he said the previous "flawed" system, which involved carrying out themed inspections on issues such as nutrition and infection control, would be replaced by one that ranked each unit of a hospital - but also looked at the organisation in its entirety.

He said the changes were based on the methods adopted by the Keogh review, which he was invited to take part in.

Sir Mike said the size of the CQC inspection teams would be increased to more than 20 - they have traditionally involved about five people - to reflect the greater scope of the reviews.

Hospital inspection

Old system New system

Inspections focussed on themes rather than looking at whole hospital. Meant sites inspected for individual issues such as nutrition and dignity.

Inspectors will now spend at least two days looking at the whole hospital, with a special focus on key services such as A&E.

Inspections resulted in hospital either meeting or failing 16 essential standards.

School-style ratings of "outstanding", "good", "requires improvement" and "inadequate".

Inspection teams limited to four or five people, often not specialists in care.

Practising doctors and nurses invited on to panels along with patients to create 20-strong teams.

Regulator uses 1,200 indicators to identify which trusts need repeat inspections.

Indicators trimmed to about 150 to give more weight to key measures such as surveys and death rates.

They will be made up of patients, doctors, nurses and other professionals - including those with inspection experience - to ensure they had greater breadth of knowledge.

He told BBC Breakfast: "We will have large teams who will go into a hospital and look to see whether it is safe, is it effective, is it caring, is it responsive to patients' needs and is it well-led.

"Then we can form a complete diagnosis of what is happening in that hospital.

"We want people who are really committed to finding out what is going on in the NHS in order to make it better."

'Robust, fair, transparent'

Under the new regime, hospitals will also get school-style ratings of "outstanding", "good", "requires improvement" or "inadequate" - something that has already been announced by ministers.

Sir Mike said those deemed inadequate could also face being put into special measures, which involves teams of external experts being brought in to ensure changes take place.

Would you volunteer as a hospital inspector?

In order to further widen the range of views taken in by the inspection, public listening events would take place during major inspections for people to relate their experiences, good or bad, of the hospital.

And he said the CQC would be paying close attention to death rates, as well as other triggers such as patient surveys, mistakes and infection rates to see which trusts should be prioritised for inspection.

The new process would be "robust, fair and transparent", he said. "Every finding will be made public."

The first wave of 18 inspections is due to start in the next month, with the aim of inspecting all 161 trusts by December 2015.

Funding of £25m for the new initiative will come from extra money announced for the CQC by Health Secretary Jeremy Hunt in April.

But the British Medical Association and Medical Protection Society have warned in a letter to Mr Hunt that Sir Mike must allow the inspector to be "independent of politics".

Dr Stephanie Bown,of the MPS, said: "It is clear there are a number of challenges facing the chief inspector, but there are also a number of opportunities.

"With political independence and autonomy, we believe the inspector can play a crucial part in improving the culture and standards of care in hospitals."


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  • rate this

    Comment number 23.

    Too many over paid managers all doing the same job badly and not enough nurses.

    And they wonder why the NHS is failing.

  • rate this

    Comment number 22.

    Everytime we have an election there are a raft of changes brought in to manage the NHS. Maybe we need to leave it alone to see how the last raft work before we start tinkering yet again!!! Yes there are too many managers, and too many health staff doing research not health care - but sometimes you need changes in one hospital or area, not the whole system. Nuts and sledgehammers come to mind.

  • rate this

    Comment number 21.

    I could tell you without a shadow of a doubt, one of the major reasons why the NHS is falling by the wayside, but I would be branned a bigot, or a racist.

  • rate this

    Comment number 20.

    Since we are spending £100bn+ a year on the NHS, and since we have had among other scandals mid Staffs, Bristol babies, Morecambe Bay, the CQC cover up, the Lincolnshire whistleblower (noting they are now on the special measures list!) I really do not see any argument against why we should not know how well or not the hospitals are doing.

  • rate this

    Comment number 19.

    I am very much interested to apply for NHS Inspector, I have been working for NHS for more than 10 years and I am really concern about the deteriorating service of Patient safety.

  • rate this

    Comment number 18.

    Aye, tougher is it? That means nothing until there are actual sackings of managers who take fat salaries to turn a blind eye to the horrors on some wards.

  • rate this

    Comment number 17.

    Hospitals don't need inspections; they just need more money!

  • rate this

    Comment number 16.

    The system is terminally borked. The solution is known.

    The solution? BRING BACK PROPER MATRONS and stop targets and form filling.

    Can I have my peerage now?

  • rate this

    Comment number 15.

    One huge mistake was to make nurses require a degree. The career aspirations of a graduate do not include emptying bed-pans and washing old ladies. No one is going to invest £50,000 in education just to carry out that sort of menial task. At a stroke, the caring profession was replaced by an army of management trainees. Now we are seeing the consequences.

  • rate this

    Comment number 14.

    Accountability is the key. If those responsible for failure were sacked without compensation standards would rise .

  • rate this

    Comment number 13.

    The comment that NHS inspections are flawed is just a cover up for saying that the Governemnt depts are flawed. Each change of government brings in new great and mostly untested plans for MPs to wallow in the glory and then it all goes wrong. By then the MP has moved on to greater things. MPs should be accountable and face the same consequences as the rest of us who work in these sectors.

  • rate this

    Comment number 12.

    Most hospitals are still running scared of MRSA,to the extent they do not want to put it on death certs,okay get tough with the hospitals but get the cleaning right,remove the contract cleaners and employ groups of women over the age of 50 who want to clean, form them into teams and give them a ward to clean,of course it is not PC but people are dying because the wards are dirty.

  • rate this

    Comment number 11.

    When the country is ruled by the balance sheet, this is the inevitable fallout.

  • rate this

    Comment number 10.

    As a former NHS worker, this is well overdue and a long time coming. For too long things have needed to be tightened up and smartened up. A real tough person who knows the standards that need to be reached, must get a tight hold on the driving wheel and show the NHS they mean business. No more unprofessional staff to be employed, ever.

  • rate this

    Comment number 9.

    Human factors are the hardest element to change in any system; it will be a monumental struggle to change the behaviour of nurses and doctors (whose performance is at the root of the problem). Much easier to scapegoat managers, particularly given that the media have been so primed for years; uncritically accepting the excuses offered by the nursing and medical 'professions'.

  • rate this

    Comment number 8.

    Ofsted for hospitals.

    Ofsted is currently being used as a tool to enforce 'academisation' (i.e. Ofsted deems that a school "requires improvement" or is "inadequate" and the DfE then enforce that it becomes an academy whether the governors believe that the most suitable approach or not). With that in mind I do worry that this initiative may be hijacked similarly.

    I hope to be proved wrong!!

  • rate this

    Comment number 7.

    Tougher checks that alright then, problem solved. The oversight of hospitals, care homes etc., only seem to act when the situation is critical. My Dad was sent a "customer satisfaction survey" from his home care providers we pay £1000 a month for & they deal with me. He is 92 with advanced dementia. Has no idea what day it is Shows what these organisations know of the conditions they deal with.

  • rate this

    Comment number 6.

    Just get rid of the pointless, useless of of cause overpaid middle management and bring back Matrons. The money saved can be used to increase front line staff use is desperately needed.

  • rate this

    Comment number 5.

    So hundreds of middle management, and they still can't run it correctly. Get rid of them and employ more matron type staff.

  • rate this

    Comment number 4.

    More Labour failures rising to the surface.


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