Eighteen acute NHS trusts are to be inspected by the Care Quality Commission over the next three months as part of the first wave of inspections under the chief inspector of hospitals’ new regime, it has been revealed.
Chief inspector Sir Mike Richards yesterday disclosed that the “first wave” includes the six acute trusts identified as presenting the highest risk under the regulator’s new surveillance system, excluding the 14 trusts investigated as part of Sir Bruce Keogh’s review of care at trusts with high mortality rates.
Under plans previously agreed by the government and CQC, all acute trusts must be inspected and rated by December 2015.
The six non-specialist acute trusts with the lowest risk and six from various points in between will also be subject to the first wave of inspection (see below). The first wave will effectively form a pilot of the new style CQC inspection which will build on the system used by the Keogh review.
This saw trusts visited by panels featuring between 13 and 23 clinicians, senior managers, patient representatives and CQC inspectors. Panels were chaired by a senior clinician.
At a press conference this week, Sir Mike said he wanted to “start building a small army” of “hundreds” of healthcare professionals to help conduct inspections.
Speaking to HSJ afterwards, the former national cancer director said this bank of inspectors would include managers as well as doctors, nurses, patients and carers. He said he could “absolutely” see the chair of inspection panels coming from a management background.
He added: “They need to be senior enough to command the respect of the people they are inspecting… It’s on the personality of that person and their gravitas.”
Trusts would be expected to release an “adequate number” of staff to do this but would be “reimbursed” for the time lost, he said.
Inspections will last a minimum of two days and cover every trust site delivering acute services. They would cover eight key service areas: accident and emergency, maternity, paediatrics, acute medical and surgical pathways, care for the frail elderly, end of life care, and outpatients.
In another change to the CQC’s regime, trusts will be made aware in advance they are to be subject to an inspection but will not be told when inspectors will visit. This advance notice is to allow for the organisation of a public meeting with patients and focus groups with staff, another element of the Keogh review methodology.
Asked whether this would give trusts an advantage, Sir Mike said it would be “almost impossible for a trust to prepare day by day, night by night” for an inspection visit.
Despite the changes to the inspection model, Sir Mike told HSJ existing CQC inspectors would remain “integral” to the process and their role would be “much more important” than providing administrative support.
He said: “What they ensure is that we do this robustly and fairly and we really do get the evidence. They are professionals at inspection and regulation. I would not want to have a panel that was without them.”
Sir Mike, who started his job on Tuesday, said a key way in which the CQC’s new methodology would “build” on that of the Keogh review was in taking a pathway approach.
He acknowledged the model was similar to that used by the first hospital inspectorate, the Commission for Healthcare Improvement, in the early 2000s.
“It has elements of that. When I was observing some of the Keogh visits I heard people who had been inspectors at that time saying that this reminded them of [CHI inspections],” he said.
“I think one of the big differences is that we now have much better information sources that will help us look at the different domains and will help us to develop key lines of inquiry so we can see where we need to be probing.”
The CQC’s consultation on its new regime runs until 12 August. The idea behind picking trusts with a variety of risk ratings is to test whether the proposed new surveillance model is effective at identifying risk.
The model uses a range of indicators organised into the CQC’s five new domains of safety, effectiveness, caring, responsiveness and being well led. The CQC will start to issue ratings against each of these domains from early 2014.
Sir Mike said he was fairly confident in the indicators selected for all of the domains, with the exception of those for well led which at the moment include the staff survey, sickness absence rates and Monitor ratings.
Despite the Keogh review finding that all 14 trusts had staff shortages, the CQC is not proposing an indicator on staffing numbers as part of the surveillance model.
Sir Mike said: “Staffing to my mind is a potential explanatory variable. We will look at the quality of care, [for example]did patients get their buzzers answered? If there are complaints about that what was the staffing level?
“One of the questions we might probe is are they really assessing the acuity of their patients and are they staffing appropriately and I think that’s a more important question than was the ratio eight to one or whatever.”
Wave one trusts
Six trusts with highest risk rating: (in alphabetical order)
Barking, Havering and Redbridge University Hospitals Trust
Barts Health Trust
Croydon Health Services Trust
Nottingham University Hospitals Trust
South London Healthcare Trust
The Royal Bournemouth and Christchurch Hospitals Foundation Trust
Six trusts with the lowest risk rating:
Airedale Foundation Trust
Frimley Park Hospital Trust
Harrogate and District Foundation Trust
Salford Royal Foundation Trust
Taunton and Somerset Foundation Trust
University College London Hospitals Foundation Trust
Six trusts at a variety of risk points in between:
Dartford and Gravesham Trust
Heart of England Foundation Trust
Royal Liverpool and Broadgreen University Hospitals Trust
Royal Surrey County Hospital Foundation Trust
Royal United Hospital Bath Trust
The Royal Wolverhampton Trust