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'Exhausted' inspectors raise concerns about unsustainable CQC regime

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The Care Quality Commission’s new inspection regime is “unsustainable”, “inconsistent” and leaves staff feeling “used, deflated and exhausted”, CQC inspectors have warned the chief inspector of hospitals.

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These warnings were among several made in notes of a meeting of the regulator’s joint national consultative committee, which have been leaked to LGC’s sister title Health Service Journal.

They reveal a wide range of concerns, ranging from requirements to work long hours away from home to the alleged inappropriate attire of some patient experts on inspection teams.

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Sir Mike Richards: “Working hard to recruit more inspectors”

One inspector described feeling “used, deflated and exhausted” while another said they felt like a “workhorse”.

“This is unsustainable”, another comment stated. “I’m exhausted and drained – no time to recover.”

The committee, which provides a forum for staff representatives to raise concerns with management, also heard a number of concerns about consistency of the regulator’s judgments, an issue previously acknowledged by Sir Mike Richards.

One inspector said they felt like they were part of a “lynch mob not a serious regulator”.

Another comment described the present system as “so inconsistent that the reports will be up for criticism by providers”.

The CQC’s new inspection regime for hospitals involves large teams of inspectors, supported by professionals working in the sector, visiting the trust over a number of days.

They stay in nearby hotels while inspections are taking place and use the evenings to discuss the day’s findings.

One inspector expressed concern that inspection teams were working late into the evening and often drinking alcohol.

The inspector said: “While the inspectors may feel this did not impair their judgment it would make good reading in the media – if the trust heard that decisions about their compliance were being made while staff were consuming alcohol any judgment may well be found invalid.”

However, another commentator complained it was “insulting” that the CQC had told staff not to drink more than two glasses of wine per night.

Inspection teams are also supported by patient representatives known as experts by experience.

However, several inspectors raised concerns about them, saying the quality of their work was “very variable” and some “have their own agendas”.

Another said: “Dress code is needed. Smart casual means different things to different people – specialists and experts by experience turning up in jeans, sweat shirts and Ugg [boots] or in micro mini skirts and stilettos. This is not the image of a professional inspectorate.”

There were also concerns that the health issues of experts by experience were not taken into account with many of them struggling with the long days they were expected to work.

A number of inspectors reported being asked to take on more senior roles without enough support or experience or being asked to cover the workload of other positions on top of their own.

Others talked of low morale and bullying and asked that their name not be shared in connection with their comments.

The meeting notes record that Sir Mike acknowledged staff were having to work excessive hours, but said things would continue to be “tough” until the regulator had recruited enough managers and inspectors.

There were a handful of positive comments with a number of inspectors stating the new model was a great improvement on the previous one due to the involvement of specialists.

Sir Mike said CQC staff had “responded magnificently to the challenge of getting our new acute hospitals inspections under way”. 

He said: “From the start we have acknowledged that we need to learn and respond to feedback to fine-tune the new inspections and ensure the model is sustainable in the long term…

“We are working hard to recruit more inspectors to ease the burden on existing staff and I was happy to meet representatives to discuss their concerns.”

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