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