Hospital inspections to be more robust, chief inspector says
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".
End Quote Prof Sir Mike Richards Chief Inspector of Hospitals
Every finding will be made public”
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.
|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.
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."