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 343.

    I wish we could dispell the myth that cost is relevant to the future of the NHS. Look on a global scale, the NHS is one of the most efficient systems for health outcomes per capita expenditure - for example the USA - which spends TWICE as much on healthcare and outcomes are the same but only for the people who can afford insurance - people who cant have long waits and basic treatment.

  • Comment number 342.

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

  • rate this

    Comment number 341.

    As usual there is total ignorance on here about what a nurse is. Nurses are qualified to a higher level and should have qualifications and do either 2 or 3 years training. What people call nurses are assistants who have little training and so cannot deal with the more complex issues. As in any other area the nurses run things and check. Assistants (ratio 5/1 or so) do the nitty gritty hygein.

  • rate this

    Comment number 340.

    Will labour be adopting similar principles in the NHS in Wales which they control & is in one heck of a mess or have they adopted the same policies as Burnham did when he became Health Minister in the rest of Britain & ignore high death rates & get reports toned down so as not to cause the party embarrassment?...

  • rate this

    Comment number 339.

    Inspections! I hope they look under the beds for the dirt and dust -thanks to the private sector, not enough staff but in a rush they bring in agency nurses at mamouth cost Why, I have never had a really bad service from the NHS but when you look around you see the problems ,stop treating health tourists make drunks pay for the chaos they cause a&e they just need a big room to sleep it off.

  • rate this

    Comment number 338.

    They were called the good old days for a reason.....they were GOOD.

    It is time we got back to basics with the NHS.

    Employ nurses who don't feel the more unsavoury tasks are beneath them, just because they have a degree.

    Employ Sisters on every ward, just like the old days. An if a nurse is below par...punish her/him.....a strict sister in charge is such a valuable asset for any ward.

  • rate this

    Comment number 337.

    Inspections - usually paper driven, have the paperwork all is OK. Have a policy for anything (whether it works or not) OK. Warning given so special arrangements can be made. Priority - old failures and failures detected at other places, gives a good chance of new ones being missed. Usually high ranking personnel inspect rather than those actually experienced at the frontline. Change - no chance.

  • rate this

    Comment number 336.

    You have to laugh at all the comments saying that inspections and regulations casued this problem.

    We were just oblivious to how many bad things were going on in our beloved NHS before this kind of regulatiom. Get over it guys, its not as good as you think it is and its one of the most expensive in the world.

    How many things are still covered up in the NHS by staff and management?

  • rate this

    Comment number 335.

    15. DenmarK
    One huge mistake was to make nurses require a degree. The career aspirations of a graduate do not include emptying bed-pans and washing old ladies. No one is going to invest £50,000 in education just to carry out that sort of menial task. At a stroke, the caring profession was replaced by an army of management trainees. Now we are seeing the consequences.

    Spot on.

  • rate this

    Comment number 334.

    I just hope that inspections cover the Cinderella depts like elderly care.
    In many hospitals if you are 75+ you are considered lucky to be alive. You are kept in bed and 'commoded' when necessary – if you have not soiled the sheets waiting for the call-bell to be answered. So if you were able to walk unaided before admission, you won’t be able to after six weeks in bed.

  • rate this

    Comment number 333.

    It seems the new regime is much like the old.
    A well meaning team (presumably by appointment) spends two days ticking boxes, then they go away.
    What is required is a patient 'champion' 24 hours a day.
    I thought that was one of the roles the Ward Sister was appointed to undertake. He/She would be in proximity to the patient for many hours each day, and act as liaison with other medical staff.

  • rate this

    Comment number 332.

    How dare the CQC trumpet this 'army of experts' as some bright new idea because it was the CQC who decided to get rid of all the experts (called 'associates') in 2009 that the Healthcare Commission had on its books. (the Healhcare Commission was one of the bodies that was merged into CQC)

    And guess what the associates did?

    They used to go with the inspectors on hospital visits !

  • rate this

    Comment number 331.

    All patients die - mostly before we've killed them.. So you learn in professional training to really care . And gallows humour. Call the combination 'integrity'. It exists, deep and wide, all over the NHS with rare exceptions.
    True, we can go badly wrong - if so that's cured by leadership never management.
    But incentives, inspections, box ticking - see Mid staffs for an example of outcome

  • rate this

    Comment number 330.

    More horror stories to come then. In any large organisation you will find problems and should be fixed. My problem with this is the people looking at this know what their masters want, which is bad news only, so they find a problem exaggerate it, and lay it before their masters feet then they will get a pat on the head and a well done my faithful servant and chuck them a bone.

  • rate this

    Comment number 329.

    on a related note, apparently 5 police forces will struggle with budget cuts... I guess covers ups, smear campaigns, ignoring rape victims, murder (ian tomlinson) and changing witness statements costs a lot

  • rate this

    Comment number 328.

    Ive worked for the NSH for 34 years and seen it steadily decline. If you were admitted to hospital 25 years ago you would have been confident in the care you received, now you would avoid hospitalisation at all costs. I had 4 hours in A/E last year and 4 doctors saw me, all asking the same questions that I had previously been asked - what a waste of time and money. Someone needs to sort it out

  • rate this

    Comment number 327.

    We don't want any of these trendy qualified nurses with degrees who know how to operate the equipment, make various measurements required, have the knowledge and education to connect side effects to drugs or treatment and so are able to warn if there is danger, and who are selected after years of character being noted in education. We need barely literate dolly birds keen to defer to managers.

  • rate this

    Comment number 326.

    All your points are took on board but labours not in power anymore fact. They are the opposition, if any mistakes they did in the PAST. Can be rectified by this PRESENT GOVERNMENT.
    The tories never wanted the nhs & in my experience never will. You lose an election for a reason, reflect, fix what was wrong, then try again. All of them are there to represent us not there own or any other interest

  • rate this

    Comment number 325.

    This will only work if QUALIFIED AUDITORS are used. Sadly withis government, ATOS, G4 and all their other GREEDY pals will get the contracts, do a cheap shoddy job, say everything is ok and the shareholders will be happy.
    As for patients, who cares, they certainly wont.

  • rate this

    Comment number 324.

    Having been to A&E on a number of occasions, there is one key problem: too few medics. They are rushing through diagnosis and making mistakes. One of them confused biliary and renal colic! This is not their fault, they lack the time to make a sound scientific judgement and mistakes are inevitable. We need more medics to deliver a quality service and that means lower pay for them -on a par with EU


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