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New hospital chief inspector will not monitor staffing levels

The Care Quality Commission will not monitor staffing levels as part of its new surveillance regime, despite the Keogh review of trusts with high mortality rates finding a clear link with low numbers of nurses on the wards.

Published earlier this week, NHS England medical director Sir Bruce Keogh’s review of 14 trusts recommended they all undertake urgent reviews of their staffing levels.

In an interview with Nursing Times, the new chief inspector of hospitals Sir Mike Richards said he saw staffing levels as an “explanatory variable”, rather than an indicator of poor care in themselves.

“We will look at the quality of care [for example] did patients get their buzzers answered? If there are complaints about that, what was the staffing level?” he said.

“One of the questions we might probe is, are they really assessing the acuity of their patients and are they staffing appropriately? I think that’s a more important question than was the ratio eight to one or whatever.”

Sir Mike, who was national director of cancer at the Department of Health for 13 years, was speaking to Nursing Times to discuss the CQC’s new inspection regime.

In future inspections will be carried out by a panel of 20 or more nurses, doctors, managers and CQC inspectors and will be chaired by a senior clinician or manager.

Sir Mike said he wanted to “start building a small army” of “hundreds” of healthcare professionals to help conduct inspections.  

“It would be ideal if we could get some nurse directors to come on the inspection panels but it will be a combination from executive board level down to junior nurse or junior doctor,” he told Nursing Times.

Trusts would be expected to release an “adequate number” of staff to do this but would be “reimbursed” for the time lost, he said.

Inspections will last a minimum of two days and cover every hospital or site with a trust that delivers acute services and eight key service areas: accident and emergency, maternity, paediatrics, acute medical and surgical pathways, care for the frail elderly, end of life care, and outpatients.

At present inspections tend to focus on two or three wards.

In another change to the CQC’s regime, inspections will also include focus groups with nurses, doctors and other staff groups, potentially including healthcare assistants. Public meetings will also be held to canvas views and experiences from patients and the public.

In order that this can be organised, trusts will be made aware in advance they are to be subject to an inspection but will not be told when inspectors will visit.

Asked whether this would give trusts an advantage, Sir Mike said while trusts might be able to prepare if they knew which shift inspectors would visit it would be “almost impossible for a trust to prepare day by day, night by night”.

All acute trusts must be inspected and given a rating by the end of 2015. Yesterday Sir Mike revealed the 18 trusts who be inspected under the first wave (see list below).

The CQC has chosen the six trusts with the highest risk ratings under the regulator’s new surveillance system, excluding the 14 trusts investigated as part of Sir Bruce Keogh’s review of trusts with high mortality rates.

The six non-specialist acute trusts with the lowest risk and six from various points in between will also be subject to pilots of the new style inspection.

The idea behind picking trusts with a variety of risk ratings is to test whether the proposed new surveillance model is effective at identifying risk.

Sir Mike said: “This is a beginning of a whole movement to being much more open about the quality of individual services and hospitals as a whole.”

 

Six trusts with highest risk rating (in alphabetical order)

Barking, Havering and Redbridge University Hospitals Trust

Barts Health Trust

Croydon Health Services Trust

Nottingham University Hospitals Trust

South London Healthcare Trust

The Royal Bournemouth and Christchurch Hospitals Foundation Trust

 

Six trusts with the lowest risk rating

Airedale Foundation Trust

Frimley Park Hospital Trust

Harrogate and District Foundation Trust

Salford Royal Foundation Trust

Taunton and Somerset Foundation Trust

University College London Hospitals Foundation Trust

 

Six trusts at a variety of risk points in between

Dartford and Gravesham Trust

Heart of England Foundation Trust

Royal Liverpool and Broadgreen University Hospitals Trust

Royal Surrey County Hospital Foundation Trust

Royal United Hospital Bath Trust

The Royal Wolverhampton Trust

Readers' comments (12)

  • "New hospital chief inspector will not monitor staffing levels"

    In that case, do not spend one single penny monitoring anything else!! If they have so completely failed to give credence to the importance of adequate staffing and the impact of poor staffing levels, then they shouldn't bother with inspections. We might as well all go home and let the government and the public figure out how to deal with the nation's health problems without staff. Let's see how they get on.

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  • anon 10:48. Stop that knee jerking!

    If you read mike richard's comments, he says they will look for problems, and if they find problems they will look to see whether poor staffing is the cause, and if it is, make the provider take action to address it.

    This is sensible and much better than checking arbitrary ratios

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  • Anonymous | 18-Jul-2013 11:14 am


    Don't patronise me!! I didn't say anything about 'arbitrary ratios'. Straighten out your own knee.

    If you are thick enough to think that CQC (a discredited and incompetent organistaion full of bullies) teaming up with nurse directors (who are responsible for many of the problems nurses face in the NHS), then you are just part of the ongoing problem.

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  • I'm not part of the problem.

    Everyone knows CQC have been weak before - but I think it is right to give new people with new ideas a chance to improve things. That's what is actually happening with mike richards.

    Critical analysis of what they are proposing is fine and welcome but condemning them as people and rubbishing their approach without taking a close look at what they are actually suggesting, assuming they will fail, assuming that they aren't professional well-meaning people trying their best to do a difficult job - that's the problem.

    we can't expect them to get better

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  • Anonymous | 18-Jul-2013 12:32 pm

    It wouldn't even occur to you that a completely new approach is needed, would it? Just assuming that those who are involved in the process, which in itself is a government knee jerk reaction, are all doing this in everyone's best interests, when there is history to suggest the polar opposite is NOT critical analysis. It is wishful thinking.

    Further proof that it is not a good idea is that the RCN (another completely failing organisation) has come out in support. Oh yeah, critical analysis indeed!!

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  • Enough of the 'handbags'. I've noticed it seems to be a good time to ask for extra staff, my requests have all been acted upon, senior managers are sitting up and listening at present.

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  • It is about time that you have "learnt" meanwhile the patients are suffering i.e. your mun & dad,/brother/sister/husband & wife/friend/family.Please be quick on delivering the service. Your approach is good, it is quality not quanity. I have worked in the healthcare profession for a number of years (as a nurse now retired) and see the good and the bad side of the service as more, and more family are relient on our NHS system (which is the best in the world, in any emergency)
    I wish you all the best.
    Regards,
    Grace.

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  • I will like to see an Intelligent tool used nationally for calculating correct and appropriate staffing for hospital wards.
    When this type of tool is used for staffing levels, then one can investigate further whether the problem is a lack of proper management or other underlying problems.

    I worked yesterday with one Nurse short, but the Sister replace this with two Carers.
    I actually worked harder than if I had the one Nurse instead of the two carers.
    I had to be telling the Carers all the time what to do. Some of it I suspect was lazyness but most of the problems I had working with the carers was the fact that they were not able to use their initiative. They at times did not seem to know what to do, in fact I really do feel that Carers must be trained more appropriately. Food charts, fluid charts, emptying catherter bags, understanding when a patient need to use the toilet, just going about giving/feeding drinks. I had to do my jobs plus keep checking on the other jobs. I did not feel any confidence in the carers I worked with. It was so hot and fustrating.

    I do quite understand that it is not always the numbers, but the quality. Management plays a big role in ensuring the right staffing levels and proper supervision with good support.
    Absolutely no bullying and no lazyness.

    Lets hope Mr Richards is well able to look into root cause of problems and sort.

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  • Anonymous | 18-Jul-2013 1:17 pm

    Sorry to disagree with you, but I was enjoying the posts from those two commentators and thought they both made valid points. Please don't try to shut down debates here. If you don't like the way people express themselves, ignore it or go elsewhere. People have a right to be angry. It shows they care about their work.

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  • So Sir Mike is looking for Nurse Directors to join his team for change? Really? Doesn't that smack of poacher turned gamekeeper? Let's have nurses by all means, but I fear that this is going to go the way of all these cosmetic initiatives.

    Item one: Scrap the CQC. Then let's take it from there.

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  • michael stone

    I declare an interst here: Mike Richards replied to an e-mail I sent to him a couple of years ago, and although he obviously had not understood the question, at least he replied. More than some people do. So Mike tends to have me 'onside' !

    I suspect - not been through this closely - that the inspectors will be looking at OUTCOMES: so if outcomes at hospitals with low staffing ratios all turn out to be pretty poor, THEN the CQC might make some recommendations about staffing ratios.

    But I don't think, at the moment, the CQC is telling hositals what to do - I think, it is going to be telling hospitals how their outcomes, compare to the average (and perhaps to 'target outcomes').

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  • If managers are failing their staff, bring in new ones who are able to fulfil their roles correctly. Poor nursing management is one of the route causes.

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