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Anatomy of a Care Quality Commission inspection

BMJ 2014; 349 doi: (Published 01 December 2014) Cite this as: BMJ 2014;349:g7353
  1. Gareth Iacobucci, news reporter, The BMJ, London, UK
  1. giacobucci{at}

Gareth Iacobucci finds out what a hospital inspection is like

Following recommendations from Robert Francis’s inquiry into failings at Mid Staffordshire foundation trust, England’s healthcare regulator, the Care Quality Commission (CQC), has revamped its regime for inspecting NHS services. The CQC’s predecessor, the Healthcare Commission, rated Mid-Staffordshire as good in 2007-08 despite high standardised mortality ratios. Clinicians and “experts by experience” such as patients are now included on larger inspection teams, while 15 essential standards for assessing services have been streamlined into five key areas: whether services are safe, effective, caring, well led, and responsive to people’s needs. Services now receive an overall rating of outstanding, good, requires improvement, or inadequate, the same metrics used by the schools regulator Ofsted. The added expenditure of implementing the new regime means the average cost of inspecting an acute hospital is now £80 000-£150 000 (€100 000-€190 000; $125 000-$230 000) depending on its size. I recently shadowed an inspection team at Kettering General Hospital, a small acute trust in Northamptonshire, to see how the new process was working in practice.

Day “0” (2 September 2014)

The day before the official inspection begins, the team meet to discuss preparation.

The trust briefs the CQC team at 4 00 pm on issues that may be relevant over the course of the inspection. At 6 30 pm the CQC and trust host a listening event at the hospital, where members of the public are asked to offer feedback on their experience of services in the past 12 months. Around 35 people attend the event.

Day 1 (3 September)

The team assemble at 8 45 am. Lead inspector Fiona Allinson asks the team to look for any trust-wide problems that they spot such as lack of cleanliness or compliance with audits. The team divides into seven subteams of 5-6 people, each led by an inspection manager employed by CQC. The seven …

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