Alan Milburn's inspection reform finally puts the NHS and private hospitals on the same footing, says Daloni Carlisle

Published:25/04/2002, Volume II2, No. 5802, Page 14

The much-heralded reform of hospital inspection is at last upon us. A new inspection and audit commission is to report not just on NHS hospitals in England, but also on private and voluntary hospitals. It is a change that is welcomed all round, putting the private healthcare sector on a level playing field with the NHS for the first time.

This latest reorganisation has been in the offing for over a year.

The King's Fund, the Audit Commission and the Independent Healthcare Association have long called for a rationalisation of inspection. Last August, HSJ reported on 'turf wars' among the plethora of inspection bodies as it became clear that something had to be done about multiple inspections and general confusion over who does what and why.

The Commission for Healthcare Audit and Inspection was announced as part of the Budget and presented to Parliament in a new document, Delivering the NHS plan. It will bring together the inspection role of the Commission for Health Improvement, the audit function of the Audit Commission and the registration and inspection of private and voluntary hospitals carried out by the National Care Standards Commission.

Similar arrangements will be discussed for Wales.

Health secretary Alan Milburn put CHAI firmly in the context of raising standards: 'We need higher standards in the NHS, and there must be higher standards in private hospitals too, ' he said.

The move represents a huge shift from the days of former health secretary Frank Dobson, who was implacably opposed to putting the NHS and private sector under a single umbrella. It recognises the increasing role that the private sector is playing in healthcare.

More than 70,000 NHS patients have received care in private facilities under the terms of the concordat between the two sectors signed last year.

Primary care trusts are now free to purchase care from the most appropriate provider, whether public, private or voluntary.

The independent sector has given the new arrangement the thumbs up. 'We are looking forward to it, ' says Independent Healthcare Association spokesman Peter Fermoy. 'What we want is a level playing field for the inspection and its regularity.'

The current system of inspection for 2,000 independent hospitals and clinics has only been in place since the beginning of April, when the NCSC got off the ground. But already it was looking outdated. Last month junior health minister Lord Hunt said CHI would take responsibility for inspecting all facilities used by NHS patients - including the private sector and NHS pay beds.

There are also discrepancies in the regularity of inspection, with CHI expected to visit NHS hospitals once every four years and NCSC inspectors descending on independent hospitals every two.

While CHI bases its inspections on expert peer assessment, NCSC uses standards drawn up by the Department of Health in consultation with the independent sector.

'There is been an argument for some time that the [private] hospitals would be better placed with the NHS side, and NCSC could then concentrate on care homes, ' says BUPA medical director Dr Andrew Vallance-Owen.

CHAI will put like with like - or as another anonymous independent sector source put it: 'It will stop us being lumped in with care homes in Burnley.'

Only the vaguest outline of CHAI's future shape has emerged so far. It will be independent, with commissioners appointed by the Independent Appointments Commission rather than ministers. The commissioners will appoint their own chief inspector to report to Parliament annually.

There is no timescale yet for CHAI opening for business. At a press briefing last week, Mr Milburn was unable to say anything more than he 'hoped' to put the necessary legislation forward in the next parliamentary session, and we should see its first inspection report before the next general election. Nor did he know how it will be funded and how independent of central government that will be.

So in effect it will be business as usual for CHI, the Audit Commission and NCSC for at least 18 months. 'Until the new bodies are established, we will continue to regulate all the services that fall under our current remit, ' says NCSC chair Anne Parker. But they will also be paving the way for CHAI - and that is where new battles will be fought, not least reconciling the two very different inspection methodologies.

Dr Vallance-Owen supports keeping NSCS's standards - indeed he was BUPA's representative on the committee that drew them up. 'The standards are transparent and they are good.

Obviously we geared up to them and a huge amount of work has been done to make sure we comply, ' he says. He favours applying the standards approach to the whole sector, but asks: 'Are we going to end up with two methodologies, one for the NHS and one for private hospitals?'

CHI communications director Matt Tee says: 'It is much too early to talk about whether NCSC standards will be incorporated, and that will be up to the new body.'

CHI argues against a standardsbased approach for the NHS because of the lack of common benchmarks and other problems.

As Mr Tee says: 'Internationally, there is concern that a pure standards-based inspection can lead to behaviour which is designed to comply with standards and not at how you improve the quality of the service.'

But if the independent sector really is to be put on a level playing field, Dr Vallance-Owen argues that other regulatory bodies will also need to broaden their remit. 'At the moment, the National Clinical Assessment Authority is not allowed to consider doctors who work in the private sector. Similarly, the National Patient Safety Agency. There is an argument for them having a brief to cover the whole sector.' l Delivering the NHS Plan .The Stationery Office.

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