Nearly three-quarters of hospital chief executives believe the government’s proposed overhaul of regulation and inspection will be ineffective.

In a joint HSJ/Capsticks survey of the most senior people in England’s hospital sector, 73 per cent said they did not believe the introduction of a chief inspector of hospitals would be effective.

The plan for the new senior role at the Care Quality Commission was announced by the government in response to the Francis public inquiry report into failings at Mid Staffordshire Foundation Trust.

Health secretary Jeremy Hunt confirmed the plans on Tuesday and said the chief inspector would act as the “whistleblower in chief… acting without fear or favour of vested interests”.

The chief inspector’s role will include identifying areas of poor patient care and publishing ratings of hospitals on a four-point scale. Information on failure will be passed to the NHS Trust Development Authority or Monitor, which will take enforcement action.

Chief exec barometer

Fifty-one hospital chief executives responded to the HSJ/Capsticks acute barometer, in the past month.

There was widespread opposition to some of the government’s other policies in relation to Francis.

It has opposed statutory regulation and registration of healthcare assistants, but most chief executives said it was a good idea. On Monday Mr Hunt said that, instead of registration, the government would promote minimum training standards.

But 80 per cent of respondents to the barometer survey supported statutory registration.

Hospital chief executives were split evenly on the issue of a criminally enforceable duty of candour.

HSJ asked respondents to set out whether or not they would support a legal duty of candour and making it a criminal offence for “any director [to] provide information to a patient or nearest relative intending to mislead them about a [serious] incident”.

Equal numbers were for and against. Chief executives comments ranged from describing such a move as “entirely appropriate” or “excessively draconian”.

The government is currently proposing to introduce criminal sanctions for organisations which do not inform people “if they believe treatment or care has caused death or serious injury” and “provide an explanation”.

One chief executive commenting in the survey said: “Honesty is always the best policy, however difficult. Isn’t this common practice across the NHS? Why do we need a law to help us break bad news?”

Another said: “I think it is shameful that we have come to a time where it is found to be necessary to consider making it a law that anyone employed in high public office must tell the truth.”

Asked to identify any general issues of concern, one commonly identified was the rise in emergency activity at hospitals.

One chief executive described the situation as a “meltdown” and another said the policy of non-payment for many emergency readmissions meant 2,800 patients at their trust had effectively been treated at no cost to commissioners during 2012-13.

Another, identifying a different issue, said: “Nobody seems to be making the link to the financial environment hospitals are working in. It is more challenging than the situation Mid Staffs faced for many organisations, yet the risk, particularly linked to the 30 per cent tariff, seems not to be mentioned.

“Most emergency patients are elderly and the 80-plus numbers are growing. The phrase ‘disaster waiting to happen’ comes to mind.”

Honest about candour

Chief executives were split almost exactly evenly when asked what they thought of new “duty of candour” laws and the recommendation in Robert Francis’ report to make it a criminal offence “for any director [to] provide information to a patient or nearest relative intending to mislead them about a [serious] incident”.

Five for

  • “Entirely appropriate.”
  • “Candour not an issue since this is what we should be doing anyway. Similarly, the criminal sanction should not frighten any director who operates true to NHS values.”
  • “Doing it already so not a problem.”
  • “Right and necessary.”
  • “Agree with proposal.”

Five against

  • “Complete and utter nonsense.”
  • “Excessively draconian.”
  • “The police and Crown Prosecution Service have more serious issues to deal with. The burden of proof would cost an awful lot of tax-payers’ money in legal fees. Proving intent would be a challenge.”
  • “It will put people off applying for the roles and we will lose the good people we have.”
  • “I think a duty of candour is good but making it a criminal offence is not. We deal with people who are emotionally charged and the criminal justice system will be used in an inappropriate way.”

Exclusive: Hospital leaders say 'chief inspector' role won't work