• Several NHS providers successfully challenged their draft inspection rating from the CQC
  • These include Salford Royal FT and St Helens and Knowsley Teaching Hospitals Trust
  • CQC says its “factual accuracy” process is a key part of the inspection, but adds that rating changes are “rare”

Three NHS providers successfully challenged the Care Quality Commission to improve their draft inspection rating last year.

Data obtained by HSJ suggests that, during 2018-19, at least three trusts convinced the regulator that the overall rating given in their draft inspection report was incorrect. Their ratings were upgraded in the final reports.

St Helens and Knowsley Teaching Hospitals Trust was given a “good” rating in its draft report, but successfully argued it should have been “outstanding”. The final rating was given in March 2019, and represented an upgrade on its “good” rating from its previous inspection. 

Information from the CQC’s database said the trust’s underlying ratings had been incorrectly aggregated.

Rotherham Doncaster and South Humber FT received a “requires improvement” rating in its draft report, which would have been a downgrade on its previous “good” rating. The trust also convinced the CQC the underlying ratings had been aggregated incorrectly. It was ultimately judged to be “good” in June 2018.

Salford Royal FT was given an overall “good” rating in its draft report, before being rated “outstanding” in its final report, released in October 2018. This meant it was the first acute trust to retain its outstanding rating following a second inspection. The information contained in the CQC’s database suggested it was simply that the overall draft rating had been wrongly stated, which was confirmed by the trust.

The rating system for NHS trusts was introduced in 2014 and includes a process in which providers can challenge the factual accuracy of the draft findings before the reports are finalised.

The CQC’s ratings database, from which details were obtained by HSJ through a freedom of information request, suggest there were at least four occasions since 2014 where a trust’s overall draft rating was successfully challenged.

The fourth was Sheffield Health and Social Care FT, which received a “good” rating in March 2017, after challenging the “requires improvement” verdict in the draft report. The challenge related to the impact of the trust’s primary medical services on the overall rating.

HSJ also approached St Helens, Rotherham Doncaster and South Humber, and Sheffield Health and Social Care for comment, but did not receive responses. 

The CQC said it has published 601 overall ratings for NHS providers since fully implementing its inspection process in March 2014. This means the proportion of overall draft ratings that changed was fewer than 1 per cent, according to the data.

The increase in overall rating changes in recent years may be explained by a judicial review finding in 2016, in which the CQC was told to strengthen the factual accuracy process by involving someone independent of the inspection.

However, the regulator said it was unable to give definitive answers about the number of rating changes, as the data provided represented instances where the relevant box within its database had been ticked. It said definitive answers would require manual searches of all inspections, which would exceed the cost limit under the FOI rules. 

The database identified 27 instances in which domain or service-line ratings had been successfully challenged since 2014, four of which included a log of the overall rating being changed.

Ted Baker, the CQC’s chief inspector of hospitals, said: “Our quality assurance process includes giving providers the opportunity to share their views on the factual accuracy before reports are finalised and published.

“We give thorough consideration to this feedback and if this leads to a change in the evidence we will review whether the ratings proposed in the draft report should change.

“Our commitment is to produce strong and clear reports, which reflect the quality and safety of care. Feedback from providers is an important aspect of this, and it can on rare occasions result in revision of our draft ratings.”

Article updated at 3.30pm to include confirmation from Salford Royal FT that its challenge related solely to the overall rating being incorrectly stated.