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 203.

    If you see something wrong correct it if you can or report it if you cannot. But don't forget to check that it has been fixed. Trouble is all these degree qualified NHS staff only know how to have a meeting about who should do the work. Could always get a contractor in, or do a review or an inspection. Did the inspectors fix anything. No - they write reports. No hope.

  • rate this

    Comment number 202.

    I am deeply suspicious that there is an ulterior motive behind the constant stream of bad stories about the NHS and the BBC. It is easy to find points to criticise and spin into badness in any large organisation and undoubtedly things need to be improved but the NHS and the BBC are two cornerstones of British life and those wishing them privatised do so at their peril.

  • rate this

    Comment number 201.

    Triggle propaganda machine again.

    This inspection business is a red-herring.

    Last Monday , took a patient to hospital, seen almost immediately, FEV tests done, saw Dr.couple of mins later,scanned, pleural fluid sample taken, referred for CT.

    Excellent surroundings, lovely staff, 1st class medicine.

    OUR NHS!

    REPEAL Health & Social Care Act 2012.

  • rate this

    Comment number 200.

    @ 125

    yup, its always someone elses fault isn’t it, pass the buck, typically public sector mentality, do as little as possible, zero accountability, clock of and go home, still get paid (well) and get a gold plated pension.
    That’s what the police were doing when they ignored rape victims, didn’t want the bother, and why should they bother, they have jobs for live with great packages

  • rate this

    Comment number 199.


    Diversity manager, that's a popular NHS non-job. Will these inspections take into account how much money is wasted on non-essentials?


  • rate this

    Comment number 198.

    The Govt needs to remember that Hospitals are NOT businesses, its about caring for people. They have made so many changes based on saving money that they no longer have enough staff and resources to do the job. People will continue to die and care will suffer until they remember what the NHS was about. Its about providing free, good quality, health care to all. You cant put a price on that.

  • rate this

    Comment number 197.

    Too many bean counting managers, too few dedicated frontline staff. This is not just a NHS issue - in the Crown Prosecution Service (CPS) they are reducing frontline staff but not managers, then asking for volunteers to work overtime because there aren't enough frontline staff to cope !!! Madness.

  • rate this

    Comment number 196.

    Matron would sort it out in a day

  • rate this

    Comment number 195.

    There is a concerted agenda by Hunt and this Government to destroy the NHS!!!
    It's happening every day now - continuous slating of the NHS in the media and right wing press - it's disgusting. They really shopuld be ashamed of themselves AND remember that when they are on the brink of death - it will be the NHS that DOESN'T save their life because THEY destroyed it!!!

  • rate this

    Comment number 194.

    One, just one, of the problems with the NHS is that many managers are not qualified and have no recognisable management qualification. Thus they make up their day to day duties, lack personnel communication skills, and frequently finish up on paid sick leave because they haven't the skills to cope.

  • rate this

    Comment number 193.

    Faster spins the coin of farce & tragedy, to find the affordable number of very good people to reward sufficiently to keep them good at making us good against our wills or our fear and greed, the latter comically due to all being in competition to appear so very good as to deserve those very high salaries & protections enough for families & pensions should we be discovered 'not so good'

    Who wins?

  • rate this

    Comment number 192.

    Perhaps the inspection team should have a good look at 'Decision making in the Dept of Health'.
    Rupert's puppet Jeremy Rhyming Slang needs to cut the spin and Daily Mail distorted headlines and get to grips with increasing needs. Cut the politics for once and answer this simple question "What will the NHS look like in 10 and 20 years time" and be honest for once.

  • rate this

    Comment number 191.

    So the inspection were pathetic, what a surprise!

    Just like the inspections of councils where a 'show' is put on for the isnpectors, observed meetings are run with no councillors arguing or controversy so a full score is obtained for a 'well run' council chamber. What a farce, typical public service patting itself on the back.

  • rate this

    Comment number 190.

    174.Broadford Boy

    uh huh, and if you bothered to read it there is a over 60 million a day being wasted on the EU when it could be used to sort out problems in the NHS and many other areas in our own country, irrelevent drivel ? i think not, try working in a warehouse in London that employs 400 people with 75 % of them being Polish, all of which work for a Polish work agency, Sad fact of Britain.

  • rate this

    Comment number 189.

    Is it the inspection of the hospital, or the inspection of the patient, that's to be tougher. It's ambiguous and we need to know.

  • rate this

    Comment number 188.

    I would love to be a hospital; inspector, 20yrs ago my mother was in Stafford hospital where she nearly died through lack of care, dirty bedding,dirty floors and poor hyergiene I complained officially. Move on to 2012 she was in Stafford hospital again not much improvement. There was however plenty of clerical staff walking round with bits of paper and not doing a lot.

  • rate this

    Comment number 187.

    They need to do something drastic about hospital "care". If, instead of admitting my dear mum to hospital, I kept her at home, then withdrew food, drink, and medication until she died of thirst, would the judge accept that I had merely given her the "Liverpool Care Pathway" or would I rightly be locked up for murder?

  • rate this

    Comment number 186.

    Does no one else find the timing of all this a little suspicious? Funny that problems in the NHS - which have been known about for years - are only now being brought to the fore as the Tory government seek to privatize our state. Even our health and well being has become an cheap excuse to fulfill their ideological agenda.

  • rate this

    Comment number 185.

    Its all about honesty and accountability and it appears that the trouble started when neither was practiced.Inspections should be unannounced and ad hoc,so any shortages of staff are picked up upon and bad practices identified.

    People should be employed because they care,not because they are simply after a career pathway (and that goes for doctors as well nurses)

  • rate this

    Comment number 184.

    In 1997 Labour inherited a broken and destroyed NHS. It made mistakes between 1997 and 2010 certainly with an over reliance on PFI and getting obsessed with targets but the NHS they left behind as Francis and Keogh have factually pointed out was infinitely better and far more fit for purpose than they inherited.Ignore the spin and false claims and it is clear "The NHS is not safe in Tory hands"


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