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 163.

    So six different quangos wasn't enough to monitor adequate patient care then?

    About sums up all that is wrong with the NHS. More directors, more managers, more administrators but zero accountability from anyone.

  • rate this

    Comment number 162.

    In a word, QUANGO.
    Yet more hot air from a bunch of do nothing but meddle nanny state. This sounds like a good idea. But will be ineffective gross waste of money, as the old school tie network will syphon off the money set aside. Whilst they patronise the public into believeing this is change. There is only transparency of our PCs by the state

  • rate this

    Comment number 161.

    How about a system where the patients give kudos for good treatment received. Patients only complain, in writing. They rarely praise, in writing. There are a huge number of good staff in the NHS who go unrecognized.The system, at present,only encourages complaints. Who would want to work in the NHS under these circumstances. The balance is being woefully misrepresented.

  • rate this

    Comment number 160.

    Had dealings with the NHS the past months areas appear to have a lack process & communication between teams is poor.As a software developer I find it quite astonishing in an organisation of this size with the resources at its disposal.

    Is it garbage in garbage out? I went for a blood test & the nurse asked me why I was there because the details had not been entered on the computer. Simples!

  • rate this

    Comment number 159.

    Inspections and public service institutions are a package deal. The reason being, because they serve society, is that they are highly accountable for their actions. What we have here is a more thorough and simplified inspection that medical professionals can have a say in. Providing that this new inspection isn't held up by red tape, I fail to see what the problem is.

  • rate this

    Comment number 158.


    It has improved tremendously. For example, our local hospital now has 6 radiotherapy machines costing at least £1m each when they had none previously. It has many brain, cardiac and renal machines that it never had previously. In terms of equipment and services, it has tripled in size. Don't forget the expensive drugs. We still spend less than other countries.

  • rate this

    Comment number 157.

    Its hardly surprising that problems in NHS hospitals run deeper than the sloppy administration that has characterised the service from day 1. It is absolutely right the those running these institutions need to held to proper account. We'll know when the inspection system is working when some of the highly paid executives are put on improvement programmes or fired.

  • rate this

    Comment number 156.


    "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."

    In many cases that would be liking asking Dracula how to improve the blood bank

  • rate this

    Comment number 155.

    When are we in the UK going to learn that you cannot inspect quality into a system. Inspection regimes only add-cost for a negative return.

    In all of this debacle, everybody misses the obvious. There is no substitute for good management. All the failing hospitals, are or have been badly managed.

    There is no substitute for good management. Go and ask Gerry Robinson.

  • rate this

    Comment number 154.

    Tories this Tories that, not one mention of the mess the Labour party left this country in, you want to know why all the cuts are being made ? ask Tony Blair, sooner we leave the EU better, close the borders and stop paying out money to scrounging Europeans that are only here for the free handouts, then and only then will this country be able to get back on its feet

  • rate this

    Comment number 153.

    Someone must explain how spending can treble, from £30Bn odd to more than £100Bn in 12 years, with no appreciable patient benefit.

    -That would be terrible fortunately as identified by then independent Kings fund in their review of NHS from 1997-2010 there were massive tangible improvements in the NHS both in terms of patient satisfaction and clinical outcome.

  • rate this

    Comment number 152.

    Our NHS hospitals are already short-staffed because of lack of funds, and potential staff moving into the private sector, but a 'small army' of doctors and nurses are going to be doing checks? So, are they supposed to fit it into what little free time they'd otherwise have, or will they be taken out of their usual roles to do the checks? Either way, the NHS service will be negatively affected.

  • rate this

    Comment number 151.

    Having had a few dealings with the NHS over the past few months my view is that many areas appear to have a lack of proper process and communication between teams is poor.

    As a software developer bod I find this quite astonishing in an organisation of this size with the resources at its disposal.

    Not sure what all the Managers are doing but it isn't overseeing basic processes.

  • rate this

    Comment number 150.

    Politicians are simply playing at what needs to be done.
    It is impossible for the NHS ever to deliver an affordable service in the future. It is simply too big, and impossible to ever manage effectively.
    Radical reform by breaking it up and privatising, is the only answer.
    Unfortunately our gutless politicians will never have the courage to tell the truth, for fear of loosing their jobs.

  • rate this

    Comment number 149.

    Labour started this. privatisation process with their cowardly PFI system to fiddle the books. Now the Tories have a foothold to rob our NHS and hand it over to their greedy mates. It may be time to take to the streets and protest to save the NHS. The corrupt police force we have may take violent action against us because it does not affect them they are all with BUPA ,on our money

  • rate this

    Comment number 148.

    Jeremy Hunt ? is that the same Jeremy Hunt who got caught trying to trade BSkyB for Tory propaganda to Rupert Murdoch.....say no more.

  • rate this

    Comment number 147.

    Government need to educate the population on the costs of the NHS.
    Whilst GP visits should remain free, they should introduce a mandatory £25 charge for everyone visiting A&E and a £100 charge for scheduled operations. That way people understand the value of the service the tax payer funds.
    In addition some form of identity scheme is needed to prove you are entitled to a subsidised service.

  • rate this

    Comment number 146.

    Hav`nt read all the comments but can I assume that someone has already made the point that any inspection will be just the usual box ticking fiasco unless it`s made without prior warning to the people being inspected?

  • rate this

    Comment number 145.

    Hunt who did not get the shunt. Is playing party politics for all he is worth with DC's encouragement. His delivery of the Gov's response to the last report was appalling. A party man to his back teeth He has no interest in 'health' except to get attention on himself, especially if Gove has been hogging the headlines, with sound bites. NOT a commendable leader of NHS which needs professional aid.

  • rate this

    Comment number 144.

    This is not about caring for patients. There is no reason to suppose that this investigation will be any more helpful than previous ones. It is about fault finding so that hospitals can be labelled as failing and then privatised.


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