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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  • Comment number 143.

    This comment was removed because the moderators found it broke the house rules. Explain.

  • rate this

    Comment number 142.

    The standards of civil society can only be maintained if rigorous comprehensive competant inspection is maintained.

    Accross the whole spectrum of public services, inspections are inadequate.

    From councils not inspecting contractors works & just paying them, to child protection services to care homes to hospitals.

    Bridges are inspected more rigorously & regulary than many services.

  • rate this

    Comment number 141.

    110 HTG - who swears on their professional oath

    "First do no harm"

    Words cannot describe the pathetic impotent rage of anyone whose loved one has been treated to the worst of the NHS.

    And the deep anger against those who covered their own backsides and the institution as they proceeded to repeat it again and again and again.

  • rate this

    Comment number 140.

    On the rare occasions I have had to use the NHS I have never had anything but excellent care and attention.The Tories have one political aim which is PRIVATISATION and then exploitation to make money for private companies.The abject failure to ensure plain cigarette packets and to enforce minimum alcohol pricing will merely place MORE strain on the NHS.79-97 saw dereliction of investment in NHS

  • rate this

    Comment number 139.

    I now have private med ins & live abroad the COUNTRY I KNEW HAS GONE"

    Yet another who can't see the immense irony that their solution to increasing immigration to this country is to become an immigrant themselves somewhere else. Please enlighten us as to where this pure-blood WASP paradise is? 'cos it ain't in the USA, Canada, Oz, S Africa and any other country I'm aware of.

  • rate this

    Comment number 138.

    Great to see Prof Richards’ comments that he wants to involve patients. However there is nothing in the acres of coverage about how the ordinary patient might put their name forward for an inspection team. Without an open “recruitment” process there is a great danger that the patient inspectors will mainly be representatives of a variety of special interests.

  • rate this

    Comment number 137.

    Very similar to, old style, school Ofsted inspections. Unless they are without warning then the inspections can be "managed" over the two days. The hospital can then get back to normal. The added stress will not improve patient care. Instead;

    Reinstate matrons, or the equivalent.
    Allow whistle blowers to be supported and heard.
    Increase ward staffing levels at weekends and nights.
    Offer 24/7 care

  • rate this

    Comment number 136.

    My Girlfriend has been a practising nurse now for 3 years. She works insanely hard, 12 hour shifts often with out more than a 20-30 minute break. Coming home in tears and covered in bruises is a regular occurrence. The hospitals around this country are severely understaffed and that is the root cause of the drop in standards of care. Less paperwork and more nurses on the ground is what we need.

  • rate this

    Comment number 135.

    The Tories are setting up the NHS to fail. They need an excuse to privatise it.

    If it is privatised medical treatment will be dependent on ability to pay rather than need. Don't let them fool you otherwise.

    Keep greed out the NHS.

  • rate this

    Comment number 134.

    -This is what the Keogh report actually says regarding the last Governments tenure not what Hunt and the right wing media says it says.

    “Between 2000 and 2008, the NHS was rightly focused on rebuilding capacity and improving access after decades of neglect. The key issue was not whether people were dying in our hospitals avoidably, but that they were
    dying whilst waiting for treatment.

  • rate this

    Comment number 133.

    Someone must explain how spending can treble, from £30Bn odd to more than £100Bn in 12 years, with no appreciable patient benefit. No other benchmark is necessary; any organisation whose costs increase 3 times over with no improvement/increase in output is clearly dysfunctional. The ratio of nurses to beds has improved, we have more doctors than ever; and more administrators. Something's wrong.

  • rate this

    Comment number 132.

    118 - Steve: "Just remind me who was the Government in 2011-12 which is the period when the Keogh reviews figures come from"
    You're wrong, Steve. Excessive death rates in 2010/11 and 2011/12 were used to identify underperforming trusts for the review. The Keogh report figures cover 2007-2012. So, Coalition Government identifies problem trusts and takes action, unlike Labour from 2007-2010.

  • rate this

    Comment number 131.

    I actually think this is a good idea, however it will not work.
    The real problem is that the NHS is simply too big to ever get right. It consumes over £100 billion, and employs more people than any other organisation in the world. It simply is too big to ever work well.
    The only way to have an affordable and good service in the future is to break it up, and privatise.
    Hard message, but the truth.

  • rate this

    Comment number 130.

    I've got a radical idea. Mr Hunt, why don't you ask the professionals (Consultants, Doctors, Nurses, Health Workers, etc..) how they would improve the services the NHS provide. Ask anyone what happems when management devise operational procedures without asking any input from the people on the ground you get failiure.

  • rate this

    Comment number 129.

    The problem with hospitals is the staff! They walk around without any urgency, drinking coffee and making small talk when There are a bazillion patients waiting around, either that or they are on their break. I have also noticed that most of them are overweight which doesn't set a good example. They need a good kick up the backside and maybe they will be able to process more patients. Jesus wept.

  • rate this

    Comment number 128.

    I was an RMN. The training included General Nursing training. I have also been a patient many times for various surgeries in different hospitals. My late husband had a short stay in a local hospital. His treatment and care was disgraceful, attitudes of nursing staff were very poor indeed. I did make official complaints for which I received apologies, too late to help my husband.

  • Comment number 127.

    This comment was removed because the moderators found it broke the house rules. Explain.

  • rate this

    Comment number 126.

    Bad GP contracts are one example of waste. GP's get paid bonuses for clinics. I know of one example from a few yrs ago where GP's got 30000 bonus for offering a clinic at the surgery. They never even attended the clinic. The nurses ran it and the doctors passed them a couple of hundred from thier bonus as thanks. No wonder there is no money for the basics like cleaning and food.

  • rate this

    Comment number 125.

    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!

    =>Come on, stop slagging off those who do he work. The fault lies with politicians and their utterly appalling regulator the CQC who should get a heavy negative bonus for failure.

  • rate this

    Comment number 124.

    Professionals are stifled by excess management, promoted via networks not intelligence or experience of the service.
    Like the cabinet minister.
    Watchdogs = lapdogs this side of the channel.
    Inspectors are in the club.
    Recommendations go to management to implement.
    So the real problem- poor management- never gets tackled and still more pressure put on the front line.


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