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 183.

    Infirmaries were where you went to die, hospitals were where you went to get well. Now we have regional centres without enough beds or staff to permit either. NHS is for Patients to be given treatment. They cannot do this if the staff and beds are not there.
    The NHS has played a big part in increasing life expectancy it is NOT FAILING it is doing very well but some bits could do better.

  • rate this

    Comment number 182.

    We have just implemented the new EPR system,(electronic patient records). I am now looking after a computer instead of my patient. Too many managers/auditors walking around with clipboards making sure you have ticked your boxes to justify their jobs. Most of them do not have any clinical experience at all. We need more nurses, not managers!

  • rate this

    Comment number 181.

    Why not just scrap the NHS, it obviously isn't working?

  • rate this

    Comment number 180.

    The demands on everything are so great & complex that it is impossible to maintain them at public expectation or full competance.

    The complexitys of so much in the world due to unsustainable growth, is according to many world experts, on track for a serious crash/break down in mid 21st century. This track has been measured/watched/recorded over last 30+ years.

    Failures WILL increase

  • rate this

    Comment number 179.

    Like with anything to do with govt, It has to have a TOP HEAVY architecture. Of grossly overpaid paper carriers. See whitehall and NHS for living proof of both. Get rid of the unecessary top heavy management structure. Spend those billions saved on front line staff, and Drs.

  • rate this

    Comment number 178.

    The problem with government decided metrics is that they are ultimately proxies whereas businesses have metrics more directly related to business performance. Businesses also (usually) set incentive pay based on actual improved cashflow which funds the incentives. Setting metrics and incentive pay based on activity rather than cash or outcomes incents perverse behaviour with the results observed.

  • rate this

    Comment number 177.

    @139Total mass rain you got that right 2 years continuous? Now you've got a weeks sunshine you're moaning again Where I live pal I pay for everything Doctors Hospitals Dentists the lot Theres no Dole here like the land of free & easy, plus I own a property in Wales that's not free either Thatcher & now Cameron despise the NHS incidently a Welshman invented it. Flashman will sort it 2015 vote Tory

  • rate this

    Comment number 176.

    Directors, Managers, Boards, Commissioning Consortia, Confederations, Care Quality Commission, Politicians, General Medical Council, Royal College of Nursing the list goes on and on. No wonder unemployment is falling - everyone seems to be involved!

  • rate this

    Comment number 175.

    This country MUST get away from the easily manipulated finance driven tick box system of proving whether or not something is working.
    It is currently destroying the education of our children and any chance that they may have of succeeding in the global job market and it has failed our health system to an extent that too many people died who should have lived - the only reason why it got noticed.

  • rate this

    Comment number 174.

    @154 Jon.
    Did you not notice this article is about the NHS?
    Only the dimmest of Ukippers could come up with such bile-filled - and entirely irrelevant - drivel.
    The NHS's problems are entirely home-grown.

  • rate this

    Comment number 173.

    What an amazing idea, employ qualified people and have enough of them to do the job properly!
    Now they just need to roll this concept out across the NHS, instead of cutting jobs and funding and then inspecting to see what has gone wrong. Then the already excellent service provided by most Trusts will be available to everyone!

  • rate this

    Comment number 172.

    After his testimony to the Leveson enquiry, in any other industry, the "Minister for Murdoch" would have been suspended; and then sacked for gross-misconduct. If any of my team had secretly texted a senior official of a tenderer during contract negotiation, then they would have been sacked on the spot.

    Now he's running the Health Service, Just about sums this country up!

  • rate this

    Comment number 171.

    We pay over 60 million £'s a day into the EU and for what ? so they can tell us about human rights rubbish and we cant sell our food by the pound. How many doctors and nurses, teachers and police officers could we employ for 60 million a day ? Instead we get told what to do, the workplace gets flooded with cheap labour and most of what they earn is sent home and not even spent in this country

  • rate this

    Comment number 170.

    As if doctors and nurses haven't got enough on their plate already, they now have to work as inspectors too.

  • rate this

    Comment number 169.

    This government WANT the NHS to fail, that's what you have to remember when reading ANY story by ANY media outlet.

  • rate this

    Comment number 168.

    The Return Of The Nasty Party

    The politicians have used this situation to play political football.

    This time it was Jeremy Hunt who has proved himself nasty, arrogant and undeserving of being a politician.

    As much as I have little time for Andy Burnham, I feel in this instant he has been made a complete scape goat by the return of the "Nasty Party."

    It shows how little our MPs actually care.

  • rate this

    Comment number 167.

    148. Marc_MeWurdz

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

    Yeah the guy who apparently didn't know his special advisor (Adam Smith) spent all day communicating with Ruperts team.

    Now he manages the NHS.

  • rate this

    Comment number 166.

    Is this real or sound bite for the next election?

  • rate this

    Comment number 165.

    If all doctors looked like Leah Totton then all other shortfalls can be forgiven!

  • rate this

    Comment number 164.

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

    -The American Based Commonwealth Fund also identified that the NHS moved from bottom of their list of 15 National Public Health Services in 1996 to Equal Top in 2007 based on Clinical outcome and efficiency of service


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