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 323.

    I was given basic first aid education while in the scouts.
    I had to accompany someone to hospital recently due to them having an accident.

    For the second time I was appauld by the lack of BASIC CARE afforded to persons entering "Medical Profession Facilities".

    The nurses of today just stood about nonchalantly while their patient bled.

    Even if seasoned, this is not a professional attitude.

  • rate this

    Comment number 322.

    "What is this weird fetish for MATRONS? Hattie Jaques was an actress in comedy films. There never ever was a real time equivalent"

    That is the most obvious wind-up comment on any HYS board in ages

    Caution! Do not feed the troll

  • rate this

    Comment number 321.

    How many times have hospitals been closed &new built because the design of them is not forward looking enough

    One party closes hospitals, another reopens the, services are shuffled to smaller local buildings then often shuffled back again

    MUCH of UKs problems , especially waste of taxpayers money & constant re-design of systems NHS/education etc is due to lack of majority political consensus

  • rate this

    Comment number 320.

    This is like "lessons will be learned". It is actions people need to see, not nice fancy words. And by actions, I do not mean nice, cosy committees set up that are drenched in Conflicts of Interest that beset many Medical situations. We need hard-hitting independent voices that do not shirk from making hard hitting evaluations, regardless of political impact or mates' professional sensitivities.

  • rate this

    Comment number 319.

    What is this weird fetish for MATRONS? Hattie Jaques was an actress in comedy films. There never ever was a real time equivalent.

  • rate this

    Comment number 318.

    Having worked as a medic in the NHS for over 30 years I can honestly say that the lunatics are now completely running the asylum.
    I'm afraid the decline is irreversible unless the politicians never ever ever get involved in running healthcare services in the UK.

  • rate this

    Comment number 317.

    Yet another scheme and reorganisation that will no doubt cost more money. Unless each city has multiple hospitals, patients will always choose the one that is closest. At the end of the day you want to be near to home and your family when illness strikes. Hospitals need political independence and autonomy. And who wants doctors and nurses taken away from healthcare to partake in management roles?

  • rate this

    Comment number 316.

    "..a 'small army' of doctors, nurses, patients and carers to carry out inspections"

    More time wasting!

    We need to return to leading from the front line, something like a third of NHS overall staff costs are lost to management structure, that could buy a lot of front line skill.

    As good nurses will tell us all it's mainly a front line staff shortage problem and too much in managing.

  • rate this

    Comment number 315.

    Public Sector workers are generally lazy, incompetent and enjoy a "sick-note" culture.
    There are obvious issues with management too.
    So let's scrap it, and get real!

  • rate this

    Comment number 314.

    Closing down CHCs was the worst decision ever, they were visible and complaints were dealt with very well. They were disbanded PPI Forums then set up, they were disbanded and now LINks which no one knows. As long as the panels will not be hidebound by the NHS and far less paperwork, then on they should work. All involvement with patients, their care and cleanliness should be paramount issues.

  • rate this

    Comment number 313.

    One thing I have not seen in any of this reporting is some sense of scale of the problem identified. 11 Hospital trusts in special measures. How many trusts are there in total? What % of overall patient numbers were these 11 dealing with? 1%? 5%? 10% 40%? The report results were bad, but can't tell how isolated/widespread the identified problems are.

  • rate this

    Comment number 312.

    One factor which is common to all organisational failures such as NHS and BBC is lack of robust financial governance and strong leadership. Why do the professional "Quangocrats" keep getting put into these highly paid positions when all they seem good for is chairing endless meetings without actually achieving anything. Dumping these people and not re-employing them again would be a good start.

  • rate this

    Comment number 311.

    299.The Bloke
    ".... our European neighbours have better healthcare than us. And it's mainly private sector."

    The govts of the more advanced european economies have tended to act for the longer term than ours, and there isn't such a culture of expecting high returns over the short term, so I'm not surprised privatisation works over there. We are ripped off over here for so many things.

  • rate this

    Comment number 310.

    Definately more of those old fashioned matrons are required, worrying about wether uniforms are neatly starched and if the (must be entirely female) staff can turn a shapely leg, and wear short and tight enough uniforms, for all the dirty old blokes. It is also important to keep those femists and left wing trendies out who worry about people dying and the less well off and more ill patients.

  • rate this

    Comment number 309.

    The only we can guarantee that patient, especially elderly and vulnerable people are cared for properly whilst in hospitals and care homes is to fit every room with CCTV 24 hours a day!

    I am currently writing a complaint and I have shocking dictaphone recordings!

  • rate this

    Comment number 308.

    The fundamental problem of our NHS is that those public mangers are very ignorant in science. They are unable to bridge over scientific findings to clinical applications. Again, they are trying to use the old methods and old knowledge to solve the new diseases and new infection problems in hospitals. They will fail miserably.

  • rate this

    Comment number 307.

    The NHS committed itself to paperwork rather than concentrate on the real job of putting patients first.

    Somehow SENIOR Management became too focused on that task and forgot all about basic health care.

    It is not "Fine" to look in hindsight at these problems.
    They should NEVER have happened.
    SENIOR MANAGEMENT was supposed to be in charge and they should be rewarded for their errors. SACK THEM.

  • rate this

    Comment number 306.

    What is needed are more nurses who are not too proud, because they have degrees, to work at ward level with the patients instead of sitting behind a computer or filling all day. Nurses in this country are becoming more like the americans, who elicit patient wellbeing from tick sheets, The worst thing thay ever did was degree courses for nurses and stopping enrolled nurse training.

  • rate this

    Comment number 305.

    Hospitals need more Matrons like Hattie Jacques in the Carry on Films. They would make sure these hospitals are up to scratch. It seems that there is no one in charge of these wards. If there is then they want the sack.

  • rate this

    Comment number 304.

    More inspectors may be Ok but without proper daily control nothing will change. Where have all the matrons gone ?? We never had such poor service years ago. Each area needs a Foreman to oversee and set standards not highly paid managers who barely leave their offices and certainly never roll up their sleeves to lend a hand. It's always the lowly paid that receive the new rules first.


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