‘Heavy-handed, expensive’ inspections wrong way to regulate hospitals, says ex-CQC chair

Speaking at a Royal Society of Medicine event on Wednesday, Lord David Prior, who is now the chair of NHS England, said “very few” physicians will have improved their work after reading a report from the regulator.

He added that there is a role for the CQC to move in when “things are going wrong” although he is “sceptical” the regulator can actually drive improvement in hospitals.

Lord Prior said: “I am highly sceptical as to whether or not CQC or any regulator can really drive improvement and drive the top hospitals to make them better.

“And certainly I think there’ll be very few physicians who will say that their clinical work has improved as a result of reading a CQC report.

“I think the sadness I have about CQC is that we have not been able, or it has not been able, to develop a series of predictive metrics that could replace these very heavy handed, very laborious and very expensive visits that we used to do.”

Lord Prior was chair of the CQC from 2013 to 2015 and served at the Department of Health as minister for NHS productivity from 2015 to 2016.

He said that while there is a role for regulation it shouldn’t be overstated, and a two-day visit is unlikely to get “under the skin” of a hospital. He added that there was “no point” carrying out inspections unless they are “highly targeted”.

He said: “You need good people on the inspection.There’s no point turning up in the maternity department at UCLH with people who are not treated as serious people by the obstetricians and the senior nurses. There’s no point.”

The CQC has for several years been indicating it will carry out fewer inspections, being more guided by data, and placing less burden on providers.

A spokesman from the CQC told HSJ: ”Our new strategy sets out a future-focussed approach that makes increased use of data and insight as well as people’s experiences of care, which we will use alongside risk-based inspections to ensure an up-to-date picture of quality.

”However, inspection will always be a valuable tool for understanding the quality of care, and for some services in particular, physical inspections - conducted by teams which include clinical specialists and people with lived experience - are especially crucial, providing an assessment of quality that data alone is not always able to.”

Clinical leaders can make “amateurish” executives

When asked why a higher proportion of doctors from overseas had applied for a trust chief executive role, Lord Prior said “too many clinicians” approach management roles in an “amateurish way”.

“These are big, serious organisations that require serious people to run them and I think in the US and in Europe clinicians will often do an MBA, so they will have very strong financial management training as well, which you need to have”, he added.

Doctors from abroad appointed to chief executive roles at large hospitals trusts in England have included Marcel Levi at University College London Hospitals Foundation Trust and Tracey Batten at Imperial College Healthcare Trust.

Digital over integration

When asked about health system reform, Lord Prior said that he believes digital will have a bigger impact on healthcare and integrated care systems, adding that a move to digital health will be “transformational”.

He said: “For me, the major reform that is going to happen is the way that the digital world is going is going to come into the use of healthcare.

“I think that will have a bigger impact than integrated care systems so I happen to be in favour of integrated care systems…

“I think we will see a move towards digital health that will be transformational, as it has been to the banking world. If you look at the way that the banking world has been transformed over the last five years I think healthcare will move in the same direction.”