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CQC hospital inspection review launched


17 June 2013

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The Care Quality Commission (CQC) admitted it was ‘not looking at the right things’ before launching a consultation into the way hospitals are inspected. 
Proposals up for consideration include a single ‘OFSTED-style’ rating for hospitals, a programme for failing hospitals and ‘action’ where providers fail to meet the fundamental standards of care. 
The eight-week consultation follows the publication of CQC’s strategy, Raising standards, putting people first, which was released in April. 

The Care Quality Commission (CQC) admitted it was ‘not looking at the right things’ before launching a consultation into the way hospitals are inspected. 
Proposals up for consideration include a single ‘OFSTED-style’ rating for hospitals, a programme for failing hospitals and ‘action’ where providers fail to meet the fundamental standards of care. 
The eight-week consultation follows the publication of CQC’s strategy, Raising standards, putting people first, which was released in April. 
The plans follow on from recommendations made in the government’s response to the Francis report into the failings in Mid Staffordshire Hospital. 
CQC chief executive, David Behan, said: “This consultation is a critical step towards making root and branch changes to regulation.
“We are determined to make the right changes to help us make sure health and social care services provide people with safe, effective, compassionate and high quality care.”
‘Comprehensive vision’
This consultation focuses on hospital care, with a further consultation on adult social care and general practice to follow later this year. 
Mike Farrar, chief executive of the NHS confederation congratulated the CQC for setting out a “comprehensive vision” of how it plans to raise NHS standards. 
Yet he warned: "Regulators and other national organisations must be careful that new proposals do not create a duplication of information, taking up valuable staff time and diverting resources away from care – that is in no one's interest. 
“The NHS Confederation is currently working with CQC and other regulators as part of our bureaucracy review to make sure we avoid these very problems and free up more time to focus on delivering better care and smarter information for staff, patients and the public.
"As the CQC further develops its plans, they must be worked up in partnership to ensure that any change implemented is to improve the quality of care for patients and not merely to satisfy targets."  
Proposed changes 
Information from whistleblowers and the Royal Colleges will be included as a source of information for CQC inspections. 
However, the regulator will continue to use inspection teams but they will be led by a chief inspector. 
Most inspections will be longer and more thorough than the existing approach. CQC will focus less on the numbers of inspections it carries out and more on the number of days spent inspecting. Inspections could last 20 days or longer and most will remain unannounced.  
The proposals will strengthen CQC’s powers to address quality failures.  Under the new plans it will be easier for CQC to prosecute providers who breach fundamental standards, without the need for a formal warning. 
Providers will be legally required to meet these standards to remain registered. Organisations such as NICE and NHS England will lead on developing the definition of high quality care to support inspectors in identifying providers which perform at this level.
Ratings
The ratings of healthcare providers will be published as a result of inspections, based on a one to four point scale: inadequate, requires improvement, good and outstanding. 
An NHS acute hospital trust will receive an overall rating, plus service level ratings, it is proposed. Each of a trust’s hospitals will also have an overall rating.
These ratings will seek to be the definitive statement of quality of care that is useful for people who use services.
To achieve this CQC proposes that the rating comprises of the inspection judgement, indicators and the findings of other organisations, such as the royal colleges. 
Dr Mark Porter, Chair of the British Medical Association (BMA) council, said: “We support the intent to review hospital performance but do have concerns that Ofsted-style ratings have the potential to reduce a highly complex activity, in this case measuring healthcare performance, to a simplistic measure.
“Such a measure would not be a full reflection of the quality of the numerous complex services assessed. It could only ever be a blunt indicator and risks giving a highly misleading impression. It could also have serious consequences to patient care if underperforming services are overlooked and not addressed within an organisation that has a good overall rating."
CQC Chair, David Prior, said: “These changes mark a break from the past for the CQC. We have not been looking at the right things when we have inspected hospitals and we have not had the right level of clinical expertise to get under the skin of organisations.
“These proposals firmly put patients at the heart of what we do.”

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