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CQC reveals overhaul of inspection regime

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The Care Quality Commission is about to launch a massive overhaul of its inspection regime which could see the best hospitals go five years without an inspection and the worst face intense scrutiny, HSJ can reveal.

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Under the new regime, to be introduced from next month, the quality regulator will abandon annual inspections for NHS organisations and ditch its generic approach to health and social care.

Instead, inspectors will work under one of three newly created chief inspector posts responsible for hospitals; social care; and primary and integrated care. The current inspection workforce, many of whom come from the CQC’s predecessor, the Healthcare Commission, will be split into specialist teams depending on their area of expertise. It is expected mental health will be spread across all three, depending on setting.

In addition the chief inspectors will each be supported by five national teams who will go into the most challenged organisations to conduct “deep dives”.

In an exclusive interview with HSJ, CQC chair David Prior said the national teams would focus on the bottom 10 to 20 per cent of hospitals, which will receive “a lot of attention” under the new risk based system.

By contrast he estimated there will be about 20 per cent of hospitals which were “excellent” and will only be inspected once every five years unless their circumstances changed. A further 40 per cent classed as “good” will “probably” not be inspected “more than once every three years”.

For the remainder, described by Mr Prior as the “coasting hospitals”, the regularity of inspections will depend on their trajectory.

The CQC will develop a new metric to determine risk, which is likely to include results of staff and patient surveys alongside mortality rates and information on serious untoward incidents.

Mr Prior told HSJ: “I’m pretty persuaded that we can put together some metrics that are fairly predictive… When you triangulate, the same hospitals come up. There are 50 or 60 hospitals that are struggling.”

He said finances would form part of the metric and hospitals struggling finically could expect greater scrutiny.

“If you’re under great financial pressure you’re going to be looking at all your costs, staffing numbers in particular,” he said.

Inspections of hospitals will double in length – lasting between six and nine “people days” and almost always include a patient representative in the form of an “expert by experience”.

The “deep dive” teams, he said, will have about five permanent members of staff but would draft in experienced clinicians and senior NHS managers on secondment to assist them, probably for a few days at a time. The teams would also conduct some detailed reviews of particular patient pathways, most likely beginning with the frail elderly, Mr Prior said.

As reported by HSJ earlier this month, in future the CQC plans to inspect against four domains: safety, effectiveness, experience and leadership and governance.

Mr Prior said more work was needed on how to evaluate leadership and governance could be reviewed during routine inspections, but it could include measures such as staff absence and turnover.

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