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 563.

    My concern is that there are managers who have no concept of the term 'provision of quality care'; placing more emphasis on the 'quantity of care' simply to meet 'Trust targets' as it looks good, irrespective of patient needs. There are a significant waste of resources within the NHS, & managment of this nature/mind set is a classic example.

  • rate this

    Comment number 562.

    bbasic @553
    Input above all, you are right

    But there has to be a fierce team-spirit, backed-up by freedom of sensible people to make suggestions, share failures, call for justifications, offer criticisms, propose trials, suggest more training, staff set in old ways moved aside, suspect results NOT 'let pass', NHS status NOT used to stay in sub-standard private practice

    Easy in EQUAL partnership

  • Comment number 561.

    All this user's posts have been removed.Why?

  • rate this

    Comment number 560.

    It's been muted before but I'll say it again...I'm nearly 63 and have had too many hospital visits, yet they have given me a good insight into our NHS. Under the stewardship of matrons the day to day running of wards was superb, so what's wrong with actually bringing them back? It would be cheap and quick, so cut the talk and get it done - for my life's sake, at the very least!

  • rate this

    Comment number 559.

    555. I do hope you are joking.
    My manger wants to cut services to patients putting them at risk. I have a professional responsibility to do my duty to protect patients. This is whilst maintaining my job (caring for patients). I hope you never need to access the NHS where managers bully staff into silence. Hitting finance targets is their goal and to hell with patients, what a great NHS future

  • Comment number 558.

    All this user's posts have been removed.Why?

  • rate this

    Comment number 557.

    You can inspect all you want, as long as the high level managers who destroy things are rewarded with bonuses and promotions nothing will change. Banking, politics, FIFA, healthcare, etc etc. It's the complete lack of accountability that causes all the problems. If you can get away with murder because you went to Eton, why wouldn't you murder?

  • rate this

    Comment number 556.

    Are you rumplestiltskin? Did you fall asleep in 1979 and have just woken up?
    This has nothing to do with trade unions.

  • Comment number 555.

    All this user's posts have been removed.Why?

  • rate this

    Comment number 554.

    545.Tio Terry
    We are not disagreeing: there should be benchmarks and targets, The point is that they need to be the right benchmarks and targets, preferably set by clinicians and patients, not politicians, or accountants, or management consultants, or lawyers. If they are the wrong targets, you get unforeseen consequences. The road to hell is paved with good intentions.

  • rate this

    Comment number 553.

    @548 Tio. Care cannot be measured its as much an attitude as a practice. Improvement is a matter of perception - by patients and families mostly, but a caring manager or professional watches and sees

    Working in healthcare I have to accept death as normal - because it is. Everyone dies, now often after considerable years in care. So it is necessary to lose blame - its a barrier to learning.

  • rate this

    Comment number 552.

    540. Tio Terry
    'How do you measure current performance. Without that how do you determine how to improve things and then formulate plans for improvements'

    You sound like an accountant. One of the reasons the NHS is in such a mess is the constant interference from the big four accountancy firms whose understanding of public healthcare is non existent.

  • rate this

    Comment number 551.

    539. I have support from them. I am meeting with the CE so my manager can explain themselves and listen to my concerns over proposed cuts in service when there is capacity to expand with existing resources. I could be looking at constructive dismissal for not staying quiet, but if we don't speak out every health worker is culpable for failing their patient in their care

  • Comment number 550.

    All this user's posts have been removed.Why?

  • rate this

    Comment number 549.


    I have a better idea. You deny NHS treatment to anyone who abuses or assaults any NHS staff member or patient. You get the courts to charge medical treatment costs incurred by the NHS for violence, domestic abuse and other physical and mental assaults. Insurance companies get charged for fees when there is a RTA so why not other forms of crime.

  • rate this

    Comment number 548.

    i can understand you want to improve things but if you dont set a baseline how will you ever know if you have improved things?

    Where you are in a business where people lose their lives you will never, ever, lose a blame culture, someone has to be to blame until proved otherwise - and thats the right thing. Nobody should just accept death as "it's normal".

  • Comment number 547.

    All this user's posts have been removed.Why?

  • rate this

    Comment number 546.

    Meanwhile in other news not covered by the BBC (WHY?):

    "The government on Thursday sold off the NHS-owned company supplying safe blood plasma on which thousands depend. It was sold to a US private equity firm with a reputation for aggressive asset-stripping."
    As predicted by many, the NHS is being sold to American health entities bit by bit and as secretly as possible.

    What's the BBC for?

  • rate this

    Comment number 545.

    Thank you but that just reinforces my views. You have to set a benchmark and then measure performance against it. Only then can you see where the organisation is failing.

  • rate this

    Comment number 544.

    The problems started when they abolished community health councils in England.

    Mind you, this is seems all part of the governments plan to kick the NHS so they can introduce the useless private sector. The current Health Secretary did call the NHS a 60 year mistake so I think we all know where this is going. i.e. healthcare only for the very wealthy....


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