Hospital inspections: lessons to be learnt

The programme of independent hospital inspections carried out by the Care Quality Commission (CQC) was made tougher in September 2013. During the first year to the end of August 2014 under the new arrangements 38 NHS acute trusts (each comprising one or more hospitals) were inspected. The most recent inspection to be fully reported is that of the Imperial College Healthcare NHS Trust. This inspection occurred in September 2014 and details were published on 16th December 2014. Hospitals inspected within the Imperial Trust included  St. Mary’s Hospital, Charing Cross Hospital, Hammersmith Hospital and Queen Charlotte & Chelsea Hospital.

There is now sufficient data to reach some conclusions about the state of NHS hospitals and ways to make the best use of the inspectors’ findings. The general quality of CQC findings is high and they command a high degree of respect from doctors and managers. My main reservation is over the way in which the overall message is communicated rather than with the actual recommendations. Hospitals or activities within hospitals can be rated outstanding, good, requires improvement or inadequate. These ratings are very similar to and probably modelled on those applied by OFSTED. However, education has important differences from hospital treatment. A school that left out an important subject like mathematics or English ahead of GCSE’s would certainly be inadequate. However, a hospital that chooses not to treat certain conditions or that does so inadequately may be extremely proficient at treating other illnesses. Hospitals often specialise in specific diseases.

The use of terms like “requires improvement” and “inadequate” may give a misleading impression to the Public who may not interpret them in the appropriate context. For example, in the recent Imperial College Trust report the inspected outpatients’ departments were all deemed “inadequate” as was the A&E department at St. Mary’s. These results are not as concerning as the language suggests.  The Imperial Trust as a whole had an average rating of “requires improvement” as did three of the four hospitals inspected. The fourth, Queen Charlotte and Chelsea, was rated “good”. These findings are typical of those for other trusts. For example, of the 38 acute trusts against which ratings were published up to August 2014, nine were rated good, 24 required improvement and five inadequate. By far the commonest category is “requires improvement”. This fact illustrates the high standards sought and does not stop UK hospitals from being amongst the best in the world.

Apart from the risk of findings being taken out of context there are other limitations to inspections. For example; the Imperial Trust inspection was in September but the findings have only just been published. During the intervening three months important changes have occurred. The current CEO has been in post since April 2014 and requires time to implement new policies. The A&E unit at St. Mary’s has been improved considerably and reinspected the CQC, who now confirm that it is compliant. However, CQC was unwilling to publish summaries of follow-up visits at the same time as the original inspection reports. On the home page of its website CQC states:

“Our job is to check whether hospitals, care homes, GPs, dentists and services in your home are meeting national standards. We do this by inspecting services and publishing our findings, helping people to make choices about the care they receive.”

In order for patients to make the best decisions CQC should consider issuing data from follow-up inspections more quickly and taking steps to avoid misinterpretation. The good done by CQC will be compromised if patients decline hospital treatment owing to inappropriate scares leading to a lack of confidence in the NHS. Unlike hospital staff my comments are not restricted by a need to foster good relationships with the CQC.

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About Barbara Arzymanow

Barbara Arzymanow is a Research Fellow at 2020health and is a founding director of an independent healthcare consultancy firm. She has been an investment analyst specialising in Pharmaceuticals for 25 years, prior to which she carried out academic medical research in university laboratories. Her experience, obtained entirely from outside the pharmaceutical industry, gives her a unique, political perspective independent of commercial lobbies. She has extensive experience in financing the biotechnology industry, which is vital for the long-term standing of medical research in the UK. She has always been inspired by the scientific excellence within the UK and would like to see collaborations between industry, the NHS and academia strengthened. For more information about Barbara's research and writings including submissions to Government Departments please visit http://www.researchideas.co.uk . Barbara also tweets as @barbararesearch .
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