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 223.

    When you have a monopoly in any industry standards will fall. Untill we have a system where the patient dictates the financial future of GP Practices, Hospitals etc the situation will never be ideal. When we can really choose who gets our business just like plumbers and builders standards will improve automatically without layers of oversight. Have a look at The Australian model as a way forward.

  • rate this

    Comment number 222.

    Just another manifestation of the British disease, abysmal management!
    I'm afraid that the "Lions are still being led by the donkeys"

    Its not just the health service, it's the whole of UK industry, (except for the chunks owned and run by Johnny Foreigner.) The UK is the worst managed first world country.

    Remember Gerry Robinson; and the BBC series on the health service?
    Abysmal management

  • rate this

    Comment number 221.

    the NHS exists to provide those that work for it, not the nation.
    example: 30% of londoners say they dont have access to the their local GP as its closed during work hours and alot of people cant just ad hoc take a day off, so people like me dont have access to local doctor, but that doctor wont care as he gets paid well with a great pension (they still went on strike demanding more money).

  • rate this

    Comment number 220.

    This is a consequence of stuffing our hospitals with a bunch of managers who are only there to tick boxes on forms, sack the lot and replace them with the people who actually do the caring Doctors & Nurses.

  • rate this

    Comment number 219.

    "Bigger is better". NOT SO. Large hospitals require large bureaucracies to run them; are more out of touch with patients and with the communities that they serve; make patients and relatives travel long distances at great expense (and carbon usage); and pay their Chief Executives an awful lot more. more and smaller hospitals are easier to monitor and cheaper for the community.

  • rate this

    Comment number 218.

    Another eyewash. More fooling the public with new gimmicks, one different face but all others just shifted around.
    Shameful excuse for a reform. Nothing new has been discoverd, just the carpet lifetd up and the swept material shown the light of day. At this very minute any body who espouses a new idea is vicyimised, ignored or blacklisted. I know, I am one of them and have suffered.

  • rate this

    Comment number 217.

    Issues ducked:
    Allocation of spend, NHS included, hinges on use of individual & collective intelligence, in turn on ability to trust

    Even in the best of worlds, with equal partnership, all will notice instantly any change in the amount or spending-power of equal income-shares, but only carers & patients & relatives & perhaps politicians will notice changes in health cover

    Who, unequal, to trust?

  • Comment number 216.

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

  • rate this

    Comment number 215.

    @190 Jon
    I cannot believe that anyone is so crass as to believe that leaving the EU and closing our borders to Jonny Foreigner is the cure-all for UK's problems....but in your case, I'll make an exception.

  • rate this

    Comment number 214.

    In 1965 I left school at age 15 and I have paid into the system ever since.I have never been a patient in a hospital even born at home (can't remember it myself but my mum was there apparently). Anyway I am now 63 and I am sure I will need the NHS eventually. So I have a simple message for politicians stop meddling with the NHS and give me what I am due, what I have been paying in for all my life

  • rate this

    Comment number 213.

    The real problem with the NHS is the amount of badly trained and unvetted staff from oversees.

    The NHS needs to use more UK workers even though they may cost a little bit more.

  • rate this

    Comment number 212.

    (British Rail, the Water Board, the Electricity Board, the GPO, British Nuclear Fuels - remember those sell offs? I do.)
    Voting Tory when you're not rich enough to write a cheque for your heart bypass is like a turkey voting for Christmas.
    Where's our social community care gone?

  • rate this

    Comment number 211.

    less inspectors!, more nurses and doctors, once again the government chooses quangos before talent.

    Hospitals are failing because nurses and doctors are exhausted, we need more of them and less management and inspectors

  • rate this

    Comment number 210.

    It is no coincidence that many of the 'failing' hospitals are in areas of deprivation. In such cases patients may take longer to recover, but hospitals are judged on the bed occupancy time and are thus encouraged to discharge patients too early. Yes, this is part of the blame culture of the NHS, but it starts at the top - with Government.

  • rate this

    Comment number 209.

    Actually many modern managers are very well qualified on the management trainee scheme - the problem is their career progression/promotion is linked to meeting performance targets and financial balance not quality of patient care and so there will always be a tension between managers and clinicians. Patients are now seen in management priority order not clinical need priority order.

  • rate this

    Comment number 208.

    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"

    Most of that 60m (it's lower actually) comes back and the net cost is less than £20m a day. However, if you think restricting access to our largest export market is going to provide more tax revenue and funding for the NHS (especially with 2m returning Brits) you're deluded.

  • rate this

    Comment number 207.

    It shows the calibre of a political party if someone like J Hunt gets promoted from working for the Murdoch Party to Health Minister. 68880 nursing posts r earmarked to go between April 2010-April 2015 with 24836 (incl frontline staff) already gone. Hunt will argue staffing levels are not related to current pressures on the NHS. Solution (not adequate staffing) but blame foreigners/ PRIVATISATION

  • rate this

    Comment number 206.

    Usual British top heavy management, self perpetuating, has accumulated the authority so won't decide to do the decent thing and abolish itself.
    When I lived in Germany I found management's job was to back up the professionals, same in the schools, better atmosphere and less uniformity.
    Our system wastes money and demoralises the real staff.

  • rate this

    Comment number 205.

    What about the watch-dogs who should have stopped this mess from happening in the first place?
    Shouldn't they be "noose friendly," by now?

  • rate this

    Comment number 204.

    If the Managers put in charge don't allocate enough staff, and rely on locums and agencies, always more expensive than the staff, then you will get problems; but this is not a failing of the hopsitals. If i put diesel into my car and not the petrol it needs, and it judders to a halt, the fault is not with the car but with the driver.


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