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 123.

    Here we go again! The Watchers must be close to outnumbering the staff by now.The Tories are in the midst of lying about numbers who have died so they can give the dog a bad name before destroying it and handing it over to their mates to make a penny from Britons ill health.
    Labour introduced PFI which has been disastous.

  • rate this

    Comment number 122.

    This is a wake up call for Scotland, do not follow the route labour and tory governments have chosen for England!

    Keep hospital boards, keep the democratic link and above all, keep NHS Scotland free at the point of care / use.

    If current trends continue in England, the English people are going to turn round in 5 years time and ask where did our NHS go?

    Shocking state of affairs!

    C McK

  • rate this

    Comment number 121.

    I wonder if Kate's hospital has been inspected properly and is up to scratch.

  • rate this

    Comment number 120.

    This is part of Hunt's denigrating of the NHS so that privatisation will arrive as a saviour. There are problems with the NHS but Hunt deliberately steers away from the real causes in his pursuit of King Dollar for his rich masters. So he uses Bruce Keogh's report to justify his actions, even though Keogh says that Hunt's 'interpretation' is 'clinically meaningless and academically reckless.'

  • rate this

    Comment number 119.

    Finally an admission that public sector workers are incompetent.

    Now they want us to both pay for the service and manage it, next they will ask us to shine their shoes!

    clearly time to privatise, btw thanks NHS for being so pathetic that you have created the case for privatisation, thanks for loading the gun for us, but they clearly don’t care, which is why its broken in the first place

  • rate this

    Comment number 118.

    Just remind me who was the Government in 2011-12 which is the period when the Keogh reviews figures come from and which Government was it that cut the inspection budget by a Third?

    Once you have answered these simple questions would you please let the useless Hunt know!

  • rate this

    Comment number 117.

    All the "politics" are muddying the water - big questions are, will THIS methodology identify where the problems lie, will CQC be able to implement the methodology effectively, will CQC / Monitor / DH have the teeth to do make the trusts rectify the problems? Not holding my breath ......

  • rate this

    Comment number 116.

    Andy Burnam - 'I raised concerns about a few hospitals and told the Condems about it when they won the election ..... now its their fault'.

    13 yrs of pouring industrial amounts of cash into the NHS whilst allowing parts of it to abuse the old and kill people. Fobbing off their relatives.

    Burnam - 'Please re-elect me so I can have another go'.

    The chilling reality is it could well happen.

  • rate this

    Comment number 115.

    There is a BIG list of vital medication that is in short & DANGEROUS supply in UK.
    I have lost count of many times I have been in a chemist & another person has been told "sorry we cannot get these, there are supply problems, you will have to find another chemist"

    Erm excuse me we are not at war or under a naval blockage

    How many people ALSO die/suffer due to incompetant medication supply

  • rate this

    Comment number 114.

    What health tourism? There are about 3 million retired, elderly brits living in the EU. Over 1 million of these on Spains Costa del about health tourism as these elderly folk require more care and are a huge burden to the Spanish economy as most of them have not signed up with the local council.
    I suppose when the UK leaves the EU they will all return to England; better fix the NHS now

  • rate this

    Comment number 113.

    Unannounced inspection visit to get the real pictures!

  • rate this

    Comment number 112.

    You are right to be concerned Mrs.Booth,because what they used to call nursing does not exist. Nurses have no time to go for rounds since they need to fill in lot of paperwork. The emphasis of communication & documentation with Joe public's threshold for complaints and NHS compensation and expectations raising too high what do you expect. People have no idea what costs are involved, IT"S ALL FREE

  • rate this

    Comment number 111.

    I would like to see health and education delivered by competent professionals who are not scoring political points or being carried away by the power the ministers for these areas seem to have. They are not working on behalf of the patients but themselves and short term goals between elections. Improvements please by those who have knowledge of the problem and how to fix it.

  • rate this

    Comment number 110.

    Q1. Who is responsible for selection of doctors/nurses (d/n), d/n or managers?

    Q2. Who is responsible for delivery of poor patient care(c) and treatment (t), d/n or m?

    Q3. Who is responsible for monitoring c/t, d/n or m?

    Q4. Who is responsible for disciplining d/n for poor performance, d/n or m?

    Q5. Who DOESN'T get the blame when things go wrong, d/n or m?

  • rate this

    Comment number 109.

    Labour knocked hospitals down and rebuild them and leased them back which is causing lots of financial problems other problems are the world coming to have there babies and have other treatment and then they leave without paying.

  • rate this

    Comment number 108.

    A couple of comments that cameron doesn't care for NHS. Don't forget it has and will continue to look after the health of his children as well. Labour hid the truth, at least this lot are being honest. They are trying to improve things and trying to protect NHS budget from the fall out of labours feckless spending.

  • rate this

    Comment number 107.


  • rate this

    Comment number 106.

    NHS: -
    1. Dead weight and unionisation.
    2. Mr Micawber 'something will turn up' financial management.
    3. Privatisation predators hovering.

    Its doomed.

    History will rate it above organised religion in terms of harmless positive contribution to mankind.

    (Or: put in technocrats to renew corporate performance.)

  • rate this

    Comment number 105.

    @ 92. andyuk7

    We already do pay. A lot.

    I'm not suggesting privatisation - but people need to start realising there is no free or private dichotomy.

    It is also already heavily privatised. GPs are largely private contractors, the NHS doesn't make it's own drugs or equipment, private cleaning contractors are used, private catering, private car parking, private consulting firms etc.

  • rate this

    Comment number 104.

    Perhaps the NHS wouldn't be so strained if they charged at the point of entry for most self-inflicted conditions. Drink, drugs, STIs, driving, overweight and smoking being the prime conditions. Closely followed by lifestyle conditions such as vanity cosmetic surgery and IVF. The NHS is treating far more than it should do and why are my taxes paying for others lifestyle choices - again!!


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