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 383.

    These failures did not happen overnight.

    They were in progress throughout Labours administration & ultimately should have been picked up on long before reaching crisis

    The MAIN failure is political, Labour & Torys so often DENY funding for inspectorates across the whole spectrum of society specifically to AVOID fallout on their watch. Torys have CUT inspectorates so many times including HRMC

  • rate this

    Comment number 382.

    #369 bloke
    Murderously bad NHS? Hiding things? - What company would declare openly that .... Patients die:. the longer we keep them alive the greater the chance of error as a cause of death. Blaming us does not help, inspecting us is pointless, being nice would be a start. Being real would be better.

  • rate this

    Comment number 381.

    as someone who has experienced the services of the NHS from 1975 to 2003 in a series of operations, I saw the way it changed. Part of the problem is too many managers and not enough Indians so to speak.

    Regulation is needed, inspections are needed, but make MANAGEMENT responsible instead of giving them golden handshakes to destroy something else.

  • rate this

    Comment number 380.

    Good inspections are needed,the job of nursing and nurses themselves need to understand they are not a technical trade,nor white collar or a profession,they are there to NURSE,the clues in the job title,they are a hospitals primary care givers,nursing patients not treating them.

  • rate this

    Comment number 379.

    ... and when are you going to see that this is just another political foot ball (see OFSTED) to be kicked around by media and politicians to make THEM look good, as if they are actually EARNING the PAY RISE we're going to give them! Soak the RICH, Get their money which they robbed of us in the first place AND PAY YOUR PROFESSIONALS (nurses etc) WHAT THEIR WORTH! (and standards will RISE! Magic!)

  • Comment number 378.

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

  • rate this

    Comment number 377.

    It seems to be same story with the NHS that the management of departments to achieve targets set by higher authority neglects to take into account the effect on staff
    My spouse has 14yrs of caring for the elderly and infirm giving 100% every shift and dismays at poor standards along with every one else

  • rate this

    Comment number 376.

    non of this will work if the Hospital/Nursing Home etc has notification about the inspection and the Days it will take place, I have worked in various establishments , and for the duration of inspections, you would not believe the difference,....etc it doesn't matter if the temperature of bath water is correct, its the attitude of the Carer that counts all day and every day,

  • rate this

    Comment number 375.

    What is all this drivel about understaffing and pressure of work?
    If a review of all hospitals in the 1970's was undertaken it would highlight the cost and efficiency of an excellent NHS as was.
    Ward Sisters are no longer responsible for their own wards and few other staff actually understand cross infection!
    Everything is a mask of efficiency as superficial as hand spraying!

  • rate this

    Comment number 374.

    Oh dear again! HYSers get their gums in an uproar over "more robust inspections"! Well, news flash: There are SOME BLOODY GOOD NURSES OUT THERE WHO DO THEIR JOB WITH DILIGENCE AND COMPASSION! I know, I've JUST come out of a cardio ward! There are some, sadly, who don't.Ditto for every one else in NHS. Why not pay better and get THE BEST? Or are you too worried about PAYING your TAXES?

  • rate this

    Comment number 373.

    cover ups, murder, abuse of public funds, it sounds like the police but this time its the NHS... tut tut, these public sector workers really are a joke. my favorite one is the UKBA, they allowed a 37 year bag log to build up, caused in part by ignoring 3000 leads, and they threatened strike a day before the olympics began, as did train, tube and bus drivers.

    A very divided greedy nation

  • rate this

    Comment number 372.


    Unannounced inspections - good

    Name and shame the Managers - good

    Allow the medical staff to have their say to the inspectors "off record" - good

    Maybe things will improve.

  • rate this

    Comment number 371.

    If the management of the hospitals had bothered to listen to complaints from patients,relatives and visitors rather than fobbing them off and covering up bad outcomes then maybe we wouldn't be here.
    The same old 'lessons have been learned' and 'measures are being put in place' are simply not good enough.
    Now the solution is to thriow money into more inspections which as always will find nothing.

  • rate this

    Comment number 370.

    "Hospital inspections to be more robust, chief inspector says"

    these are similar stories and similar headlines from the 1980's, 1990's, 2000's and now the 2010's.

    NOTHING has changed - same broken promises, more meddling Managers, some old clap-trap from career Politicians & Health Officials, no accountability.

    The NHS farce continues with career Politicians getting away with murder.

  • rate this

    Comment number 369.

    The NHS/public sector fans are clearly intent on forgetting just how murderously bad the NHS so often is.

    The left seems prepared to brush mass killings under the table, regarding them as a minor detail.

    If a major retailer killed several hundred customers, there would, rightly, be outrage.

    Mentioning that the NHS has done so is considered as propaganda.

  • rate this

    Comment number 368.

    In the old days there were far more young healthy people and few old sick ones who died quickly. Now demographics, technology, 'the 60's', - you can waste time looking backwards or you can deal with the problem.

  • rate this

    Comment number 367.

    For years the NHS has rewarded failure by giving honours, bonuses & generous severance packages to incompetent senior managers. Until this culture of failure is ended there is no hope for the NHS.

  • rate this

    Comment number 366.

    Nurses have ALWAYS been well qualified, even back in Carry On Film days, they are usually upto A level standard. They do the complex stuff, technical and observing and co-ordinating for doctors. Care assistants do the basic stuff. If you ask the nurses in charge for someting they need to send an assistant because they do the complex stuff. So you might think the person gets your drink is kind!

  • rate this

    Comment number 365.

    Raise the bar. Standards have lowered. Bring matrons back to monitor standards on each ward and lets not have doctors walking around in trainers.

  • rate this

    Comment number 364.

    Weighing the pig doesn't make it any heavier!!!
    Why this obsession with inspection and measurement? How can inspecting hospitals in a different way possibly help to improve standards?
    Stop measuring and put the effort and money into DOING SOMETHING CONSTRUCTIVE


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