The leaders of the Care Quality Commission team that rated Hinchingbrooke Health Care Trust ‘inadequate’ today issued a strong rejection of claims that their inspection was biased.
The inspector who led the team told the CQC’s public board meeting that Hinchingbrooke was “one of the worst” providers she had inspected, while the inspection chair, who has been accused of a public sector bias, denied that he was “anti-private practice”. The trust is currently run by private provider Circle.
However, the regulator said at its board meeting today that it will be revising its policy for declaring potential conflicts of interest in light of the fallout from the inspection (see box below).
Earlier this month the CQC issued a highly critical report on Hinchingbrooke, which is the only privately operated trust in the country, resulting in it being put in special measures.
Before the report was published, Circle issued a statement announcing plans to pull out of its 10 year Hinchingbrooke franchise and that it expected the CQC’s judgment to be “unbalanced”. The company has since said it intends to challenge the rating.
The Daily Mail, which had previously written a number of positive stories about Hinchingbrooke, claimed the trust might have been the victim of a “stitch up” because one member of the inspection team had warned against NHS privatisation and another is alleged to have belonged to a group campaigning on the issue.
However, at its board meeting the CQC strongly denied the claim.
In a highly unusual move, the two people who led the inspection appeared at the meeting to recount their experiences.
Fiona Allinson was the CQC’s head of inspection on the team that went into Hinchingbrooke, and Jonathan Fielden, the medical director of University College London Hospitals Foundation Trust, chaired the inspection.
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Ms Allinson said the care at Hinchingbrooke was so poor she felt the need to phone the chief inspector of hospitals, Sir Mike Richards, to tell him about her concerns on the second day of the inspection.
She is a registered nurse who has worked in regulation for 10 years and been on 19 of the CQC’s new style inspections. She said she had “never witnessed the kind of [staff] behaviours” she saw at Hinchingbrooke, which included patients being told to soil themselves.
“I have to say it is one of the worst inspections that I have ever been to. I drove home and wanted to drive back again in my nurse’s uniform to sort it out as a professional nurse,” she told the board.
During the inspection the CQC also took the unusual step of sending the trust a letter telling it to reduce the number of beds on its Apple Tree Ward to relieve pressure on staff, which the trust subsequently did.
Ms Allinson denied the Daily Mail’s claim that inspectors had been “briefed” by a paediatrician at the hospital who is a Labour candidate in the general election.
“We spoke to 246 members of staff at the trust, he was just one of those 246,” she said.
Dr Fielden was one of those the newspaper suggested could be biased, because of comments he made about privatisation several years ago while head of the British Medical Association’s consultants committee.
He told the CQC board that while Hinchingbrooke had been the first inspection he had been on, problems with the trust had been evident to him and the concerns were shared by the whole inspection team.
Addressing the accusations of bias that have been levelled at him, Dr Fielden said: “It wasn’t an issue of who was running [Hinchingbrooke], it was how it was run.”
He said his past comments related to “mass privatisation rather than work in any particular area”, and that at the time he made them he was “in active private practice”.
“To say that I was anti-private practice I think was incorrect.”
He added that he had worked “very closely” with a number of private organisations throughout his management career, including sitting on the board of a joint venture with a private company delivering pathology services in his current role at University College London.
Dr Fielden said he had a “thick skin” but that the coverage of the inspection in the national press might make other clinicians question joining inspection teams.
Sir Mike said he was satisfied the CQC had followed the right process in reaching its judgment.
He added that the draft Hinchingbrooke report had been reviewed by the CQC’s national quality advisory group to ensure consistency.
He had also been assured by Ruth Rankine, a deputy chief inspector in the CQC’s primary medical services directorate who had been on the inspection team as an observer, that the report was a “fair assessment of quality” and there had been “no evidence of bias”.
Regulator to revise conflict of interest policy
The CQC is to revise its policy for declaring potential conflicts of interest, following claims that the political views of two inspectors may have distorted Hinchingbrooke’s inspection report.
The regulator was already reviewing its approach to the issue, with a new policy due to be presented to its board in February.
However, in the meantime the CQC has decided to revise the form it uses for declaring potential conflicts of interest.
All staff and clinical advisers who are booked onto upcoming inspections will now have to declare “other interests or involvements that CQC should be aware of”.
This will include “membership of organisations which campaign on health, mental health and social care issues” and “membership of bodies that represent the users of services the CQC regulates”.