The Care Quality Commission (CQC) has published its analysis of the quality and safety of care provided by independent acute hospitals across England.
CQC has inspected and rated over 200 independent hospitals in England, at an overall level, for their core services and for how ‘safe’, ‘caring’, ‘effective’, ‘responsive to people’s needs’ and ‘well led’ they are.
In its national report, CQC has revealed that the majority of independent acute hospitals are providing high quality care for their patients. As of 2 January 2018, 62% were rated as good and 8% were rated as outstanding.
CQC has found that most patients have prompt access to effective treatment and experience personalised care from highly skilled and caring staff. Of the 206 hospitals inspected, 89% were rated as good and 11% were rated as outstanding for how ‘caring’ their services were.
The majority of hospitals were also rated as good (86%) or outstanding (7%) for how ‘responsive’ they were. Patients were more likely to have named consultants and the hospitals managed their flow of patients well, which meant that there were few cancellations or delayed admissions or procedures.
While the report highlights many examples of good care, it also shows variation in quality and clear scope for improvement. Almost a third of hospitals (30%) were rated as requires improvement.
Safety was where CQC had the greatest concerns – 41% of hospitals were rated as requires improvement and 1% as inadequate in this area. Also, 30% of hospitals were rated as requires improvement and 3% as inadequate for how well-led they were.
In some cases, CQC found that a lack of formalised governance procedures meant that hospitals were not effectively monitoring the work of consultants who operate under ‘practising privileges’ – where a consultant clinician works in a hospital but is not a direct employee. Checks to ensure clinicians were only working within their agreed scope of practice were not always taking place. This meant that there was a risk that poor practices were not always picked up or challenged in the way they should be.
Inspectors also saw that safety procedures were not always fully embedded – for example, where surgeons were not following every step of the World Health Organisation surgical checklist.
Other issues highlighted by CQC include a failure by some hospitals to adequately monitor clinical outcomes to evaluate the effectiveness of the services they were providing, and a lack of preparation for the possibility that a patient’s condition could deteriorate.
CQC has used its inspections and ratings to help independent acute hospitals understand the specific areas where improvements are needed, to hold them to account to make the necessary changes, to share best practice and to help people to make more informed choices about their care.
Already, CQC’s actions are driving improvements in care for people and providers have been quick to respond to inspection findings taking on board CQC’s judgements and proactively addressing areas where further work is needed to improve patient care. Of the 13 hospitals that had been re-inspected, seven had improved. Four of these had improved from an initial rating of inadequate: two going from inadequate to good and two going from inadequate to requires improvement.
Professor Ted Baker, Chief Inspector of Hospitals at the Care Quality Commission said:
“Much of the care and treatment we have seen at independent acute hospitals is good – and we found that effective leadership at a local level, good staff engagement and a close oversight of the services being provided played a key role in ensuring high quality care.
“However, our inspections also identified concerns around the safety and leadership of some services, often as a result of a lack of safety checks and poor monitoring of risks. Too often, safety was viewed as the responsibility of individual clinicians, rather than a corporate responsibility supported by formal governance processes. Where we found failings, we have been clear that improvements must be made, using our enforcement powers where needed to protect people.
“As the independent quality regulator we hold all providers of healthcare to the same standards regardless of how they are funded. Having inspected all independent acute hospitals in England we now have a comprehensive picture of the quality of care they are providing for the first time – and, importantly, people can use our reports to help them make choices about their treatment.
“Encouragingly, we have seen clear evidence that our regulation is having an impact, with providers taking rapid action in response to our concerns. We want to see this continue and more providers learning from those services that are getting it right.”
Independent acute hospitals provide a range of services including surgery, diagnostics and medical care. With many independent hospitals providing services that are funded partly or in full by the NHS, they are playing an increasingly important role in delivering healthcare services in England.
CQC introduced its new comprehensive inspection programme for independent acute hospitals in 2015. This saw the start of expert led, specialist inspections that focussed on what matters most to people using services – whether they are safe, caring, effective, responsive and well-led – as well as the introduction of performance ratings of ‘outstanding’, ‘good’, ‘requires improvement’ and ‘inadequate’ to help people make informed choices about their healthcare.
The findings from these inspections have helped to inform CQC’s plans to further develop its approach to regulation for all independent healthcare services.