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 243.

    "I thought the NHS was an English system created for the English paid by the English yet anybody in the world can come here and use it for free."

    Get your facts right. It's a BRITISH system created for the BRITISH paid for by the BRITISH..

    And, by the way, started by a Welshman.

  • rate this

    Comment number 242.

    3 Minutes ago

    .[.....].ulterior motive behind the constant stream of bad stories about the NHS and the BBC

    It is their psychops to rubbish the NHS and get it handed over to the wall street thugs.

    (same with pensioners allowances(Michael Buerk).

    They now use TV continuously for negative spin.

    Do not be taken in

    Well said and true

  • rate this

    Comment number 241.

    Don't think that this is only the NHS - the private hospitals (and nursing homes) can be just as bad, if not worse. There the profit motive ensures that corners are cut.

  • rate this

    Comment number 240.

    When will people wake upto the fact that there are limits to everything.

    There are limits to numbers of fully competent people, just as there are limits to the worlds resources

    Demands of everything are increasing & a backward & largely ignorant public expect all to be delivered like some fairy story ending

    If supposid CIVIL society does not pull its neck in, it will get chopped off

  • rate this

    Comment number 239.

    The governments over the last few decades have been run down,so they can step in to privatise.
    Already we have staff cuts so save money,freeze of pay.changes of contracts,lots of pressure.
    The NHS is not a free ticket,we all pay into it and i am happy to pay my money to help others and not help greedy bankers,big companies and billionaires who are the ones who have destroyed our country,

  • rate this

    Comment number 238.

    90% of the shifts my wife works as a nurse (27 years), have incorrect staffing numbers. She is asked every week to work extra shifts because of understaffing. Things have been made far worse by the Hospital Trust having to save money. The Hospital where my wife works has very high patient satisfaction scores, yet this is never reported as it doesn't fit in with the Government privatisation agenda.

  • rate this

    Comment number 237.

    'Prof Sir Mike Richards: "We are taking on where Sir Bruce Keogh's report left off" '

    And whilst you are about fixing the mess don't forget to call me "Sir". Do you think things would improve if everybody in the NHS were given a knighthood? Somehow I doubt it.

  • rate this

    Comment number 236.

    So they've woken up at last have they? My local hospital was (and I think still is) a complete shambles but has never been hauled up for it. And I think Sir Mike needs more medics to act as inspectors. But where will all these doctors and nurses he wants come from? The already understaffed hospitals, thereby creating more mistakes by greater understaffing? That really would be a vicious circle

  • rate this

    Comment number 235.

    I thought the NHS was an English system created for the English paid by the English yet anybody in the world can come here and use it for free.

    No wonder it's bursting at the seams.

  • rate this

    Comment number 234.

    or in other words they will actually do the job there paid to do.

  • rate this

    Comment number 233.

    Like so many BBC reports, this covers only England. British Broadcasting Corporation - you will keep us informed of the situation in Scotland, Wales and N Ireland won't you? So far I have heard absolutely nothing about the situation in Wales for example. Yet in my experience many of these issues arise in my local hospital in Wales. Think of Ann Clwyd's moving testament a while back.

  • rate this

    Comment number 232.

    .[.....].ulterior motive behind the constant stream of bad stories about the NHS and the BBC

    It is their psychops to rubbish the NHS and get it handed over to the wall street thugs.

    (same with pensioners allowances(Michael Buerk).

    They now use TV continuously for negative spin.

    Do not be taken in by Triggle and the BBC.

  • rate this

    Comment number 231.

    When I lived in Germany I found management's job was to back up the professionals...

    It's a different mentality and contributes to the fact that the gap between the rich & the poor is smaller in Germany than in the UK and that belt-tightening measures don't predominantly come at the expense of the poorest people.

  • rate this

    Comment number 230.

    It's time to stop letting any government meddling with the NHS full stop.
    If any of you out there want a stop to it you need to start bending the ears of your elected politicians and get them to put the NHS in the hands of those qualified to run it, more clinically trained staff.
    Since when should trusts be competing with each other ? When indeed has the health service been a business?

  • rate this

    Comment number 229.


    You still haven't expalined why if you find it objectionable to being surrounded by foreigners in this country, it is somewhow acceptable to you when you live in theirs.

  • rate this

    Comment number 228.


    Its all true, public sector in general is a ticket for free money, I have acquaintances in the public sector, I've asked them several times what they actually do, and from what I can figure out with my degree in business is they do absolutely nothing, and some of their job titles.... there not even real jobs. I'm tempted to gather all the evidence and plaster it on YouTube, i'm fed up

  • rate this

    Comment number 227.

    Tendering and insuring quality are apposing concepts

  • rate this

    Comment number 226.

    So will it include these questions

    Which manager agreed to cod liver oil costing £89 a pack?
    Which manager created systems that kill people with excessive paperwork and unrealistic targts?
    Which manager has retired and is back 6 months later for the third time?

  • rate this

    Comment number 225.

    When oh when will those in charge realise that the target culture, and an inspection regime that enforces it, are at the heart of the problem.

  • rate this

    Comment number 224.

    Surely this is what caused the problem? In 1997 Labour added a HIGH level of regulation, causing the cost of the NHS to rocket to £1bn and the number of managers to triple. It also caused management to fall back into a "tick the box" culture rather than "be the best" which they had aimed at before.

    Increased regulation is NOT the answer.


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