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 403.

    the problem is simple to fix, do away with managers on big salarys and get someone in WHO CARES

  • rate this

    Comment number 402.

    "He wants to recruit a "small army" of doctors, nurses, patients and carers to carry out inspections and ratings."

    When will the government recognise that falling standards are due to an overbearing amount of paperwork...

    Nurses are busy trying to care for patients and write up a mountain more of paperwork they have now, these inspections will just make things even worse!

  • rate this

    Comment number 401.

    And what happens when the inspectors discover bad practices or patients being maltreated - will there by sackings and NHS staff facing criminal charges?

    Of course there won't - there will just be another round of inquiries and reports blaming "the culture", "learning lessons" and "moving on".

  • rate this

    Comment number 400.

    I totally agree with your comment 376.Hazel Roberts. Why are hospitals/nursing homes given notice of inspection? We have secret shoppers & hotel guests who get a real insite into the businesses as they are not obvious, the same should surely apply to our medical services and nursing homes. Much can be covered up if inspectors give prior notice of an impending visit

  • rate this

    Comment number 399.

    ISO9001 used to be a useful framework for auditing organizations I suspect it has now become a means of rubber stamping the process the organization uses without considering the processess effectiveness.

  • rate this

    Comment number 398.

    This is just "British Leyland" style of management at its worst. When are we going to learn that you CANNOT inspect quality into a system.

    The NHS is no different from UK industry where the HR no-hopers, or, the ISO9000m, tick the box, style of management still prevails.

    1) Targets distort any system
    2) You cannot inspect quality in
    3) Inspection regimes only add cost

    Trust your people

  • rate this

    Comment number 397.

    #387 Gerald
    Every time you experience good care its because of the dedication of those professionals
    Where there is poor care or neglect - even shocking neglect. It is in spite of that dedication - not what those people want,. Blaming carers can't help. developing professionals and systems and a culture to cope with the huge quantities of very long term care might -

  • rate this

    Comment number 396.

    This seems very similar to the thinking (and rating system) already so successfully established by ofsted, which clearly has the full support and respect of all the professionals in the education profession, doesn't it? No??
    One problem (of many) is the continuously moving goalposts, and another is the bunch of non-practitioners, failures and numpties paid tons to do the inspections.

  • rate this

    Comment number 395.

    How Russell's Hall Hospital in Dudley have escaped being on hospital list for emergency measures is beyond me. The Children's Ward is awful, too busy filling in paper work than real hands on care. I left my child on the ward alone and he was not fed for almost 10hrs. Complain to the ward clerk, nothing done. Some nurses think they are over qualified to be changing nappies and feeding kids.

  • rate this

    Comment number 394.

    @378 If it wasn't for the influx of doctors mainly from the Indian subcontinent the NHS would have struggled long ago to treat English people, never mind anyone else. This is a pig ignorant comment worthy of the BNP. The main problem is political interference combined with the internal'market' and the target culture imposed by politicians.

  • rate this

    Comment number 393.

    The socialist workers party must have finished their lunch break as they are all back spouting their political nonsence which ofter has nothing to do with the subject.
    Blah blah blah bankers!
    Blah blah blah trident!
    Blah blah blah shoot anyone richer than me!

    Your simplistic garbage is very boring, go find Arthur Scargill to worship.

  • rate this

    Comment number 392.

    Targets were right for the time; The last Government inherited an NHS that had suffered years of neglect and underfunding under the Tories. Despite the recent scandals, vast improvements have been made in reducing waiting times and mortaility rates. The Coalition (especially the Tories) are taking every opportunity to give public sector institutions a kicking to soften them up for privatisation.

  • rate this

    Comment number 391.


    I know all about it. Unfortunately most poeple are too scared to admit what they see.
    The emporers new clothes

  • rate this

    Comment number 390.

    Lions lead by Donkeys!!!!!!!!you can get a top management job in the n.h.s. as long as you have never worked in nhs there on big wages and not a the nhs should work this lot won't be happy till it is gone and you are paying private insurance... into the firms some of these mps are directors of

  • rate this

    Comment number 389.

    Alternate view - don't spend £34BN on Trident Nuclear Subs, spend £34m on mops, buckets, bleach, Mr Sheen, Vim or Ajax spinkle powder in a can and a load of scrubbing brushes and employ all the "unemployed" at "the living wage" to give the hospitals a jolly good scrubbing

  • rate this

    Comment number 388.

    Part of the problem is too many managers and not enough Indians so to speak.


    Are you mixing your metaphors or calling for a Subcontinental recruitment drive?

  • rate this

    Comment number 387.

    Sorry if this is rather silly of me
    But as managers,consultants have chosen this caring profession or as is often stated a "calling",and if they all had "a duty of care" etc,why do we need inspection teams at all?
    These people are there 24/7 why cant they notice the blindingly obvious and act upon it,why do we need another expensive layer,they cant be honest,caring,etc and do nothing about neglect

  • rate this

    Comment number 386.

    More propaganda in this Governments stragegy to brainwash the population leading up to privatisation of the NHS. No problem with tougher instpections but stop running down public services having made massive cuts and blaming them for underfunding and failure.

  • rate this

    Comment number 385.

    I think this is a radical and proactive proposal. The mix of the inspection teams to include members of the public is a huge improvement on previous approaches.. After all it is the public who are the consumers of the hospital services. I would certainly volunteer myself if given the chance. I am a retired business manager with some health issues. Can anyone tell me how to apply?

  • rate this

    Comment number 384.

    As everyone says - apart from the clueless feckless politicians who don't understand the real world - BRING BACK WARD MATRONS.

    Someone who is "houseproud" on their ward will never let their standards slip to the patients detriment.


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