Care Quality Commission to Evolve Inspection System

The Care Quality Commission is planning to cross the threshold of NHS trusts for inspections at least once annually, according to the chair of the regulator.

This is part of an overall shifting strategy for decommissioning.

The CQC is moving to a risk-based inspection regime as part of its strategy to manage its shrinking budget, which will see it target resources where the “risk to the quality of care is greatest”.

Previously the Care Quality Commission had been criticised in some quarters for its overly stringent targets and assessment of institutions.

Speaking at the Commons Health Committee on Wednesday, CQC chair Peter Wyman reflected on in the future strategy of the CQC.

“Our intention is there will be an inspection, perhaps not a comprehensive inspection, once a year.”

He added that this view was the “current thinking” of the CQC, but it was due to go out to consultation on its approach before Christmas.

Wyman indicated that the Care Quality Commission will be examining GP surgeries that are rated as good or outstanding roughly every three to five years, owing to the fact that these organisations require less assessments.

Meanwhile, those rated inadequate will be inspected “very frequently…more than once a year”.

Adult social care providers will be inspected every two years or very frequently based on their rating.

The Care Quality Commission has also signalled its intention to involve itself in two further consultations before Christmas.

According by the Care Quality Commission, the first of these will assess hospital inspections and the assessment framework which currently overarches these institutions.

And the second will be jointly conducted with NHS Improvement, focusing on the most efficient way for trusts to use resources and engage in organisation.

Although the joint consultation is also due to be released before Christmas, Wyman indicated this deadline may not be met.

“Consultation will hopefully be out this side of Christmas, the new year if not, with the view to start to pilot this in April,” Wyman outlined.

The utilisation of resources was previously noted to be a concern in the November board papers released by the Care Quality Commission.

“We continue to work with NHSI to understand their proposed assessment approach including how they intend to operationalise the assessment. Until this is in place there is a risk about our ability to consult jointly in December at the level of detail needed to allow publication of full guidance in April 2017, and begin implementation from that point as we have committed,” the documents read.

 
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Mental Health Trust Taken out of Special Measures

Norfolk and Suffolk Foundation Trust has been removed from special measures after demonstrating a serious improvement in its performance.

The FT had been in the unenviable position of being the only mental health trust to receive the lowest Care Quality Commission rating back in October 2014.

Following this inspection, the trust was placed in special measures in February 2015.

NHS Improvement has now indicated that it will remove the special measures mandate, after the Norfolk and Suffolk Foundation Trust improved in several categories.

Nonetheless, the trust was still rated inadequate for whether services are safe.

NHS Improvement and the trust will now agree an action plan to address the safety concerns, which include:

– a number of environmental safety concerns including ligature points;
– mixed sex accommodation not meeting national guidance;
– concerns about the design of seclusion and places of safety, and seclusion not being managed within the Mental Health Act code of practice; and
– staffing levels being insufficient on inpatient wards.

NHS Improvement’s delivery and improvement director for the East of England, Frances Shattock, outlined some of the positive progress made by the trust since it has been reported on so damningly.

“There is clearly much more to do to ensure that the trust sustains and builds on these improvements. We will continue to provide the trust with extensive support to ensure it is able to give the standard of care patients expect.”

Following further inspections at the trust in July and August, CQC investigators discovered that “considerable progress” had been made, in line with the recommendations of the inspectorate.

And Chief Inspector of Hospitals, Professor Sir Mike Richards, recommended the trust be taken out of special measures after finding it had “clearly gained from the intensive support of the regime”.

Richards was pleased that the mental health trust is heading in the right direction.

“Our return to Norfolk and Suffolk Foundation Trust showed significant improvement had taken place. There clearly remain areas where further work is needed, in particular with regard to how the trust manages risks to people’s safety, but we found considerable and positive change had taken place”.

The Chief Inspector of Hospitals particular noted the improvement in the perspective of staff.

“Morale had significantly improved, there were better systems for recording and learning from incidents and people’s needs were assessed, with care and treatment planned to meet those needs.”

Chief executive of the Norfolk and Suffolk Foundation Trust, Michael Scott, noted that “what we have done is engage much more with our workforce – that has been the secret of our success. That has allowed us to deliver the quality improvements the CQC have seen. What we done already is a significant cultural change, that’s what’s most pleasing.”

 
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High Court to Review Care Quality Commission Recommendation on GP Reviews

The Care Quality Commission (CQC) has agreed to review recommendations made by a High Court judge regarding its inspection process.

It had been indicated by the High Court that the complaints process should be made fairer for GP practices, with the judge ruling over the case suggesting that this could reduce litigation costs for the NHS.

The CQC was told to appoint an independent expert to review GP practices’ requests for factual corrections before publishing their inspection report, rather than leaving it solely up to the lead inspector.

High Court judge Mrs Justice Andrews commented in her ruling that there was “little point in giving someone an opportunity to make factual corrections, if there is no procedural mechanism for safeguarding against an unfair refusal to make them”.

Andrews rejected the position of the Care Quality Commission, which was that there should be no mechanism for complaining against decisions taking during the 10-day window for factual corrections.

Justice Andrews was ruling on a judicial review claim brought by private APMS provider SSP Health.

The organisation had suffered three practices being placed in special measures in 2015, following a CQC inspection which considered their services to be inadequate.

But Andrews considered the burden of expectation on the inspected party to bring a legal claim into court as being disproportionate.

“It is well established that judicial review should be a course of last resort. Moreover, this court is generally an inappropriate place to resolve disputed issues of fact. Legal proceedings are time-consuming and costly for all concerned. Both the regulator and the regulated body will be subject to financial, as well as time, constraints.”

Andrew also believes that clinical commissioning groups should benefit from an internal independent process, having stated that she was convinced that the lead inspector of the Care Quality Commission should be the sole arbiter of whether changes should be made to a report.

“An independent person within the CQC ought to be able to tell fairly swiftly whether there is or is not a legitimate grievance about the lead inspector’s failure to correct the report. Such a person should be much better placed to resolve that grievance than the court is.”

Responding to the court verdict, a spokesperson on behalf of the Care Quality Commission indicated that they would be reviewing their processes.

“As part of CQC’s strategy for the future regulation of general practice, we are looking at all aspects of our methodology to determine what needs to be improved.”

Dr Robert Morley, chair of the GPC contracts and regulations subcommittee, indicated that the attitude of the CQC had been less than desirable.

“This High Court judgement only goes to provide further proof of what so many people who have had any dealings with CQC have been saying for a very long time- the organisation needs to take a long hard look at its own processes and procedures before it continues to pass judgments on others. It’s a huge and completely unnecessary burden on general practice and as an immediate step all its GP inspections and ratings should be suspended until it has shown in can get its own house in order.”

 
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Hinchingbrooke Hospital Removed from Special Measures by Care Quality Commission

The first NHS hospital to be placed completely under private management has been rated as good as following two years in special measures.

But regulators still ruled that Hinchingbrooke Hospital must improve its emergency care.

Hinchingbrooke was placed in special measures in September 2014.

At that time it was run by Circle Health, but the hospital returned to NHS control in April 2015.

But the Care Quality Commission (CQC) inspected the hospital back in May, and discovered that significant improvements have been made to the condition of service.

Hospital chairman Alan Burns believes that the verdict of the Care Quality Commission represents “a terrific vote of confidence in our staff”.

While the Accident and Emergency department still requires improvement, Burns stated that the rapid escalation in the number of patients, coupled with national staff shortages, had scuppered attempts at Hinchingbrooke to improve the situation.

But in assessing the quality of care at the hospital, the commission discovered that there is outstanding practice at the trust.

The CQC report particularly focused on its end-of-life care for patients at a local prison and the employment of an Admiral Nurse to support people with dementia.

Inspectors also reported that the quality of conduct from staff had impressed them, with a caring and compassionate attitude particularly prevalent.

Management of the hospital also received praise, despite the criticism of Accident and Emergency.

The A&E department “is as good as any around,” sccording to the aforementioned Burns.

And the Chief Executive suggested that the 50,000 patients it was forced to deal with over the last year is simply unrealistic and has led to difficulties.

Indeed, Burns went as far as praising those working in A&E at the hospital, assessing that they “have done remarkably well shifting the department from inadequate to needs to improvement”.

The hospital chairman commented that “[demand] has gone up 8% this year and we have two-and-a-half consultants on our books, compared to the six we should have. The problems here are problems in every A&E department in the country”.

CQC deputy chief inspector of hospitals Edward Baker stated that “the trust leadership knows what it must do now to ensure further positive change takes place.”

Recent statistics have indicated that very few organisations in the existing NHS have been able to acquire an outstanding rating from the Care Quality Commission.

Some experts have thus criticised the assessment process of inspecting organisations as being excessively stringent.

 
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Pennine Acute Hospitals Trust Rated Inadequate by Care Quality Commission

Pennine Acute Hospitals Trust has been rated inadequate by the Care Quality Commission.

The inadequate rating followed the first inspection of its facilities.

Staffing levels, infrastructure, systems, culture and leadership were all considered cause for concern by the regulator.

Pennine Acute Hospitals Trust operates services across four sites in Greater Manchester.

Inadequate services were reported at both North Manchester General Hospital and Royal Oldham Hospital.

Fairfield General Hospital was rated as requiring improvement, while Rochdale Infirmary and the trust’s community services were considered to be good.

The Care Quality Commission was particular critical about the levels of safety and leadership demonstrated by the trust.

Already the Pennine Acute Hospitals Trust Has acquired over £9 million worth of financial support from local commissioners and regional and national health and social care partners.

It is hoped that this will play a major role in improving the safety and reliability of the way services are delivered at the trust.

CQC deputy chief inspector of hospitals Ellen Armistead reflected on the issues which had led to the inadequate verdict.

“We had serious concerns about the systems and procedures that are in place to keep people safe and free from harm. The trust did not have a robust understanding of its key risks at departmental, divisional or board level. In a number of services including A&E, maternity, children’s and critical care, key risks were not recognised, escalated or mitigated effectively.”

It is already well known that major concerns have been raised regarding such issues during an impromptu inspection which was conducted earlier this year.

Sir David Dalton of Salford Royal Foundation Trust was subsequently installed as the interim Chief Executive as a result of problems which were identified at that time.

The Care Quality Commission has now confirmed that the organisation will be placed into special measures as a result of these ongoing difficulties.

Dalton accepted the findings of the Care Quality Commission in a statement:

“The CQC report doesn’t make comfortable reading and whilst staff will be very disappointed with the trust’s overall rating, we welcome this report which I believe is a fair assessment of the issues facing the trust. The CQC report is holding up a mirror to the organisation and reflects very much what staff have been saying for some time on issues related to staffing pressures, inadequate systems, culture, leadership and resources.”

Recent data indicated that the Care Quality Commission has tended to file scathing and critical reports on trust across England, with a relative handful of organisations being considered outstanding.

 
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Western Sussex Hospitals NHS Foundation Trust is Third to Be Rated Outstanding

An NHS trust has become just the third to be rated as outstanding since the existing system of inspections for hospitals and other health services were introduced in England just over two years ago.

The Western Sussex Hospitals NHS Foundation Trust was particularly praised for its A&E, medical and end of life care, as well as its maternity, gynaecology and children’s services.

Conducting the enquiry, the Care Quality Commission indicated that two of the three hospitals in the region had particularly impressed inspectors during the review process.

St Richard’s in Chichester, and Worthing were said to be outstanding, while the smaller Southlands hospital in Shoreham was considered good.

The only two other trusts to have achieved this outstanding rating in the history of the NHS are Salford Royal NHS foundation trust and Frimley Health NHS foundation trust.

Indeed, it is rather common for NHS trusts to be considered inadequate and for the Care Quality Commission regulator to enforce special measures on them pending improvement.

Yet inspectors described the “overwhelmingly and almost exclusively positive” feedback from patients and their families related to this Sussex trust as being unprecedented, while there was a tangible sense of pride and being valued among staff.

There was particular praise for the way that hospitals in the region dealt with disabled people, and there had been a noticeable focus on the person and not the technology at the trust, with people been taking out of critical care in wheelchairs if not well enough to cope with medical situations.

Mike Richards, the chief inspector of hospitals, praised the quality, safety and innovation at the trust.

“Staff we spoke with were exceptionally compassionate when talking about patients and we observed kindness not only towards patients but to each other whilst on site. There was clear professional respect between all levels and disciplines of staff. We saw real warmth amongst teams and an open and trusting culture.”

Although despite the outstanding performance at West Sussex, there is still room for improvement, with waiting times for surgery and patients longer than is considered ideal.

Marianne Griffiths, the trust’s chief executive, conveyed the enthusiastic response of staff to the reports and ultimate rating of the NHS trust.

Griffiths offered her opinion that the Care Quality Commission verdict was no less than a fantastic endorsement of the trust’s program of improvement.

“This outstanding rating recognises that frontline staff have the best understanding of what needs to be done to make services better for patients and gives them the skills and support to make that change,” Griffiths opined.

The Care Quality Commission has reported on 164 trusts since it was put in charge of the process in March 2014.

113 acute trusts have been covered during this period, with three considered outstanding, 26 good, 74 requiring improvement and 10 inadequate.

As of yet, no mental health, ambulance or community health trust has been considered outstanding by the Care Quality Commission.

 
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Barking, Havering and Redbridge University Hospitals Trust Apologises Over Waiting Times

A major NHS trust has been forced to apologise to over 1,000 patients who have been denied surgery for over 12 months due to NHS delays.

Barking, Havering and Redbridge University Hospitals Trust (BHRUT) released an official apology to the group of patients who have been waiting for year and a month for routine treatments such as knee surgery.

The trust is one of the most significant in the south of the country, and clearly its performance has been below par in recent months.

Responsible for the Queen’s Hospital in Romford and King George Hospital in Goodmayes, BHRUT failed to reach requisite standards when recently assessed.

Indeed, the trust received ‘requires improvement’ in its most recent Care Quality Commission (CQC) inspection.

And the reasons behind this unsatisfactory performance could perhaps be considered particularly worrying.

In its final report on the subject, the CQC painted a picture of hospitals that were unable to meet some of the most fundamental requirements of any healthcare institution.

Both hospitals were “persistently failing to meet national waiting time targets, and some patients were experiencing more than 18 weeks from referral to treatment time” according to the CQC.

BHRUT’s chief executive Matthew Hopkins admitted that the views of the Care Quality Commission where valid, and outlined the resolve of the trust to improve the situation in the foreseeable future.

“It is crucial that patients are seen as quickly as possible and we are sorry that a lot of patients are waiting too long for treatment. We are taking urgent action, working with our local partners and stakeholders, to ensure high quality, accessible care for our patients.”

In addition, Hopkins also suggested that some of the urgent action being taken by the trust had begun to have a positive effect on the overall running of the hospitals that was responsible for.

Hopkins pointed to the fact that the backlog of patients waiting for treatment had been reduced significantly since the CQC report was carried out.

He also stated that the inspection had taken place 12 months ago, and that significant progress had been made in the year since the commission visited, and that the overall picture is now somewhat improved.

However, Hopkins also conceded that there is still “much more work to do”, and that the trust must review all of its procedures in order to deliver a more efficient and effective service to patients.

With regards to those patients still waiting for treatment, Mr Hopkins indicated that “they have been contacted and we are booking in their appointments for the coming weeks.”

 
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Former Addenbrooke’s Hospital Chief Executive Outlines Financial Predicament

An ex-Chief Executive of a major hospital has suggested that accident and emergency departments in the NHS are essentially on their knees.

Keith McNeil quit Addenbrooke’s Hospital in September, amid massive financial and organisational problems.

Addenbrooke’s faces a £64 million deficit in the current financial year, contributing to the potential £2 billion deficit in the NHS as a whole.

It is this sort of financial picture that has led McNeil to assert that Addenbrooke’s would need to close its accident and emergency department on nine days out of ten to break even.

This succinctly illustrates the massive funding issues that hospitals all over the country have in the existing NHS system.

McNeil did state, though, that a funding formula which reimbursed a hospital of 30 per cent of the cost of A&E beds, compared to planned surgery, had impacted positively on the institution.

Addenbrooke’s had been rated as inadequate by the Care Quality Commission i(CQC) n September, yet declined to reply to comments made by Dr McNeil when contacted.

The extent of problems at the hospital were further underlined by the fact that McNeil divulged that “a busy day and night in the A&E would often lead to most of our planned surgery being cancelled.”

This is a clear indication that the funding situation at the hospital is unsustainable, and clearly played a major role in McNeil’s ultimate decision to resign, as much as the opinion of the CQC.

McNeil was originally a transplant specialist, before assuming control of Addenbrooke’s in 2012.

And he stated that the hospital had never been fairly reimbursed for work that it had performed previously.

Despite the verdict of the Care Quality Commission, McNeil also stated that aspects of the judgement could be considered unreasonable.

He particularly suggested that the hospital was forced to field a large number of admissions from A&E due to the nature of the ageing population for which it was responsible.

McNeil claimed that due to the shortfall in funding caused by the high number of A&E beds, Addenbrooke’s would need to utilise 210 beds each day of its 850 adult beds for planned surgery “in order to break even”.

“Every day we were juggling to see which patients could go ahead with elective (planned) surgery and which wouldn’t, depending on how many beds were available. A busy day and night in the A&E would often lead to most of our planned surgery being cancelled the next day,” McNeil stated.

The Department of Health responded by affirming hat it was aware that finances were challenging, but encouraged trusts to live within their means.

This must surely be viewed as rather empty rhetoric if indeed the claims of McNeil are accurate.

 
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CQC wants public to share experiences of Barnsley Hospital NHS Foundation Trust

Members of the public are being asked their opinion of the services provided by Barnsley Hospital NHS Foundation Trust prior to the Trust being inspected by the Care Quality Commission (CQC) on 14 July 2015.

The opinions are to help CQC inspectors decide what to look at when they undertake their inspection.

“The new inspections are designed to provide people with a clear picture of the quality of the services in their local hospital, exposing poor or mediocre care as well as highlighting the many hospitals providing good and excellent care”, said England’s Chief Inspector of Hospitals, Professor Sir Mike Richards. “We know there is too much variation in quality – these new in-depth inspections will allow us to get a much more detailed picture of care in hospitals than ever before.

Of course we will be talking to doctors and nurses, hospital managers and patients in the hospital. But it is vital that we also hear the views of the people who have had care at any of the hospitals run by the trust, or anyone else who wants to share information with us. This will help us plan our inspection, and so help us focus on the things that really matter to people who depend on this service.

“This is your opportunity to tell me and my team what you think, and make a difference to NHS services in the local area.”

In addition to the areas to be inspected identified by the public, Sir Mike’s inspection team will look in detail at key service areas: A&E; medical care; surgery; intensive and critical care; maternity; paediatrics/children’s care; end of life care; and outpatients.

When the inspection is completed the CQC will publish a full report of the findings (scheduled for later in the year).

Details of when the listening events are taking place are on the CQC website.

 

 

 
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CQC places GP practice into special measures over safety and leadership failings

Deanhill Surgery, a GP practice in south west London, has been placed into special measures following an inspection by the Care Quality Commission (CQC).

As part of CQC’s new programme of inspections, a specialist team rated the Surgery as being inadequate in terms of safety, effectiveness, and leadership. However, the Surgery was described as being caring.

The CQC identified five areas for improvement, including: (i) the need for appropriate systems, governance and leadership to monitor the quality of the service being provided; (ii) greater disclosure and barring checks for all staff; (iii) better training in child protection and safeguarding vulnerable adults; (iv) the practice ensuring that it maintains appropriate standards of cleanliness and hygiene; and (v) all clinical and administrative staff being properly trained, supervised and appraised.

“It is important that all the people who are registered with Deanhill Surgery can rely on getting the high quality care which everyone is entitled to receive from their GP”, said Ruth Rankine, deputy chief inspector of general practice at the CQC.

“While patients told us they were treated with compassion and dignity, we found numerous issues in relation to safety, with no adequate systems to monitor and respond to risks.

 “We have found significant areas of concern, which is why we are placing the practice into special measures – and so opening the way to support from NHS England.

“In the meantime we will continue to work closely with NHS England and the Richmond Clinical Commissioning Group to make sure that all the patients at Deanhill Practice receive the care that they deserve.”

 
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CQC’s Chief Inspector of Hospitals publishes findings on BMI Mount Alvernia Hospital

The Care Quality Commission’s (CQC) Chief Inspector of Hospitals Professor Sir Mike Richards has published his findings on the standards of treatment and care at BMI Mount Alvernia Hospital in Guildford.

The hospital is one of the first independent hospitals to be inspected under CQC’s new methodology which looks at whether services are safe, effective, caring, responsive to people’s needs, and well led.

CQC identified five areas for improvement: (i) the provider must ensure that CQC is notified of any serious incidents which have occurred; (ii) the provider must consider feedback mechanisms following the reporting of incidents, and should review the arrangements for monitoring the implementation changes and other actions; (iii) the provider must amend its Statement of Purpose to ensure it reflects the service provided and the range of patients’ needs the service can meet; (iv) the provider must consider the formal arrangements required to support patients living with dementia or learning difficulties; and . This must include appropriate training and monitoring processes for the assessment of people who lack capacity to consent; and (v) the provider must ensure that the records relating to the safe use of lasers in theatre are updated and provide assurance that the consultants are trained.

“People deserve to receive treatment and care which is safe, effective, caring, responsive to their needs, and well led”, said CQC’s Chief Inspector of Hospitals, Professor Sir Mike Richards.

“Since our last inspection in 2013, there has been significant and consistent improvement, however there is still room for more. Some improvements are still needed such as making their governance processes more robust and systematic in incident reporting and compliance with practicing privileges.

“We will return in due course to check that those improvements have been made.”

 
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Norfolk and Suffolk becomes first mental health trust placed into special measures

Health sector regulator Monitor has placed Norfolk and Suffolk NHS Foundation Trust into special measures – the first mental health trust in the country to have had such action taken against it.

Monitor has acted following a Care Quality Commission’s (CQC) inspection earlier this month which gave the trust an overall rating of ‘inadequate.’

The CQC identified a number of serious problems, including concerns about the safety of services, staffing levels and the leadership at the trust.

“Patients in Norfolk and Suffolk deserve to receive the highest possible care, and so the failings that the CQC has identified in the trust’s services are disappointing”, said Katherine Cawley, Regional Director at Monitor.

“We are pleased that the trust has already started to address some of the issues raised by the CQC, but much more needs to be done. That’s why we have put Norfolk and Suffolk into special measures, to ensure that it gets the extra help and support it needs to make the improvements that are required.”

Norfolk and Suffolk NHS Foundation Trust has agreed to put Monitor’s plans into action to address the care quality concerns identified by the CQC.  Monitor has also imposed a new condition on Norfolk and Suffolk’s licence which enables the health sector regulator to take further action if improvements are not made quickly.

 Katherine Cawley: “We will continue to work closely with the trust and monitor its progress in making the improvements that patients in Norfolk and Suffolk expect to see.”

 
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