The NHS now has unprecedented information about care quality in hospitals, so what will it do with it?
The inspection of all general acute trusts by the Care Quality Commission has now been completed and it will soon have published the final ratings.
The milestone means we have the most comprehensive view of quality across the whole sector ever – but it is passing with little notice or reflection.
It is safe to assume we are judging hospitals by high standards
Part of the reason may be that the near-final ratings more or less confirm the pattern that emerged fairly early in the process. HSJ analysis shows a ratio of three outstanding: 30 good: 60 requires improvement: seven inadequate.
Are these results shameful for those working in and around English hospital services? Probably not, since there is no international benchmark and it is safe to assume we are judging by high standards.
We also know, though, that some enclaves of serious failure have inexcusably been neglected for a long time. We should be pleased to have taken the step of calling these out as inadequate, and plenty of trusts and systems have either begun or achieved turnaround.
Still, it is an apt time for the sector to reflect on the overall picture and what happens next. What have we learned, and what does it mean for maintaining and improving standards in future? After all, we now have an unprecedented, sector-wide stock of ratings (at service and theme level, as well as site and trust) and richly detailed inspection reports.
A large part of the answer – and one stressed by NHS Improvement’s Jim Mackey at the NHS Confederation conference last week – is simply to get on and do the things that are known to help, to read the report on Frimley Health’s astonishing turnaround of Wexham Park Hospital and learn the lessons.
NHS Improvement promises it will find a happier balance between challenging and helping local change
On a local basis, inspection reports for badly rated services contain a frank assessment of what is behind the problems – with common factors including understaffed wards, bullying and poor management – and a detailed roadmap to something better. For health systems, dealing with quality failures is part of the puzzle facing those working on sustainability and transformation planning – closing the “care gap”, in Forward View parlance.
At the centre, NHS Improvement has promised it will find a happier balance between challenging and helping local change, and to do the latter better. It will seek to utilise leadership from outstanding organisations which, although they are still only a handful, have grown in number in recent months thanks to Newcastle and Western Sussex foundation trusts. An interesting question is whether these organisations can be better used as management training grounds.
If successful, the new national approach will rediscover the spirit of peer review, which was a big focus in the Keogh mortality investigations that preceded the current CQC regime. Could it put energy back in the idea of using junior doctors as a force for spreading quality as they rotate around the system? There is certainly a case for seeking to harness the substantial passion and unity which medics displayed in the contract row for a better purpose.
We now have information available on a different scale
Finally, while there is no call for another grand, national review, the chance should not be wasted for a pragmatic whole-sector examination of CQC findings for new evidence of patterns and causes behind failure. It may help accelerate things we already believe in: centralisation in key specialties and circulating doctors between teaching hospitals and smaller or medically marginalised sites, for example.
It may dredge up new answers to how poor leadership, management and governance take hold and are allowed to lead to frightening deterioration; or the consequences of how NHS funds are shared across the country. It would certainly not be able to avoid the issue of constrained ward staffing.
The NHS has achieved a lot in recent decades by responding to reports of single huge care failures, but we now have information available on a different scale.