CQC sets out new inspection regime for hospitals in England

BMJ 2013; 347 doi: (Published 18 July 2013) Cite this as: BMJ 2013;347:f4631
  1. Ingrid Torjesen
  1. 1London

England’s healthcare watchdog the Care Quality Commission is overhauling how it inspects hospitals after a review of 14 hospitals with higher than expected death rates found that its current processes had missed significant problems.

The review, led by Bruce Keogh, the medical director of the NHS in England, resulted in 11 of the hospitals being put into “special measures,” meaning that they need external support to improve.1 Significant concerns were raised about the quality of care at the other three trusts.

Mike Richards, the chief inspector of hospitals at the CQC, told a press conference on 17 July that the Keogh review had shown that the way inspections were conducted needed to change. He said that the approach taken by the review was a powerful one, which the commission could build on. Richards was involved with five of the 14 Keogh inspections.

The new inspections will mean that bigger teams, headed by a senior clinician, and including both senior and junior clinicians and trained members of the public, will go into hospitals. Hundreds of new inspectors, including practising and retired clinicians, will be required.

The changes will be implemented by the end of August, and all 161 acute hospitals will be inspected under the new comprehensive inspection programme by 2015. There will continue to be additional inspections for trusts where concerns have been raised.

The commission will use a surveillance tool to bring together a whole range of publicly available information across five domains—safety, effectiveness, caring, responsiveness, and leadership—to generate a risk score and highlight any areas of concern. Safety will include looking at how many never events and avoidable infections occurred within a set time period; effectiveness, different types of mortality rates, including particular causes within specialties; caring, evidence from the patient experience survey; responsiveness, waiting time data and cancelled operations; and the details of leadership are still being worked on.

Site visits will last at least two days and cover every site that delivers acute services and eight other key service areas—accident and emergency, maternity, paediatrics, acute medical and surgical pathways, care for frail older people, end of life care and outpatients—plus other areas of potential concern. There will be an announced component to enable trusts to ensure that any required paperwork and key staff members are available to the inspection team, and to organise staff focus groups. There will also be town hall meetings for members of the public and unannounced visits, which will target areas of concern including in the evening and at the weekend.

Richards said, “What I want to be able to say at the end of this is would I be happy if my mother, my brother, my niece, or my great nephew went to this hospital. That covers the age span from frail elderly, past heart attacks, through maternity services to paediatrics.”

From January, trusts that have been inspected will receive an overall rating—outstanding, good, requires improvement, or inadequate. Trusts will also be rated on the five domains.

Mike Farrar, chief executive of the NHS Confederation, said that the new inspection regime reflected the commission’s “aim of returning to a system of specialist, thorough inspection with greater involvement of staff and the public.”

The commission has named 18 trusts that will be inspected during the first wave of the new programme—six of these received a high risk rating from the surveillance tool, six a low rating, and the remaining trusts were in between.

Richards said, “What we want to determine is can we really differentiate on the basis of the risk model between hospitals that are performing particularly well or one that may not be. And it is during this phase that we will be developing our approach to ratings.”

The six trusts with a high risk rating to be inspected are: Barking, Havering and Redbridge, Barts, Croydon, Nottingham, South London, and Bournemouth and Christchurch.

The six trusts with a low rating are: Airedale, Frimley Park, Harrogate, Salford, Taunton and Somerset, and University College London.

The other six trusts are: Dartford and Gravesham, Heart of England, Royal Liverpool and Broadgreen, Royal Surrey County, Royal United Hospital Bath, and Royal Wolverhampton.


Cite this as: BMJ 2013;347:f4631


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