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Has inspecting hospitals made any real difference to standards of patient care?

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A senior nurse practitioner and a mental health rehabilitation nurse make the case for and against hospital inspections

YES - Maria Gough

Not only have hospital inspections made a real difference to patient care, but they have also saved lives. A plethora of medical scandals over the past decade provides sufficient evidence to conclude that NHS organisations cannot be routinely relied upon to act in the best interests of patients. The Healthcare Commission is the patients’ ‘watchdog’. Their inspections ensure that NHS organisations meet the standard of quality in healthcare the public has a right to expect.

Since its inception, the commission has carried out hundreds of independent investigations that have consistently found that the real danger to patients is from systems and organisational failures rather than any single rogue member of staff.

Because of these inspections, problems have been identified and addressed. Examples of reports from 2006 included: widespread abuse of people with learning disabilities in Cornwall because of flaws in a trust’s policies and procedures; deaths in a London maternity unit due to organisational failings; and poor infection control in a Buckinghamshire trust associated with poor leadership.

Quality in the boardroom is associated with quality on the ward. The Corporate Manslaughter and Corporate Homicide Act 2007 will encourage management to embrace corporate responsibilities and any Healthcare Commission recommendations because it enables ‘the prosecution of organisations where there has been a gross failing, throughout the organisation, in the management of health and safety with fatal consequences’.

The commission’s published reports enable NHS organisations to reflect and learn from experiences elsewhere and thus all patients ultimately benefit, as do staff. After all, there is no bigger morale boost than being able to provide quality care to patients.

Inspections are just a snapshot but, over time, they tell their own story. I argue that they lessen the risk of another Bristol or Alder Hey, where tissues and organs were taken at post-mortems over a long period, while robust organisational systems will provide fewer places for another Shipman to hide. Many inspections confirm what staff suspected but were powerless to address. Overall, inspections do much more than facilitate quality patient care – they help to rebuild trust in healthcare by ensuring such trust is well-founded.

Maria Gough is a senior nurse practitioner at Harlow NHS Walk-in Centre

NO - Simon Daniels

I’ve been dreading inspections for as long as I can remember. When I was in the Royal Army Medical Corps, daily inspections of bed space and kit were ritualised, humiliating episodes. These succeeded only in instilling in me something I refer to as ‘pre-inspection neurosis’ (or PIN) by forcing me to focus on passing inspection at the expense of everything else.

I next experienced inspections in a privately run care home as a newly qualified enrolled nurse. On the office year planner was a thick red ring encircling 23 February. Months before the date, matron marched into the office and tapped the calendar with her ruler, tutting as she did so. In the week leading up to ‘I’ day, the home was given a makeover, with cheap and shoddy equipment thrown into a side room to be replaced by ‘on-approval items from the catalogue’.

Obedient staff were hand-picked for the big day and coached on how to reply. Troublesome residents were shipped off to a sister home under the pretence of room redecoration. We passed, of course.

In hospitals, the annual inspection is conducted by the Healthcare Commission. All aspects of ward-based care are marked as standard exceeded, met, almost met, or not met. Nebulous comments such as ‘required level of performance’ or ‘commendable’ are awarded with a shake of the hand. Staff experience PIN, as I did, because they worry that if they are given a fail instead of a pass, it will mean yet more inspections and widespread humiliation in the press.

In my view, inspections should always be unannounced and conducted by patients as well as retired nurses who would not obsess about ‘necessary criteria’ and ‘benchmarking’. Like mystery shoppers, an inspection should be a covert consensus, not a one-night performance with a terrible script and flashy scenery.

Even if the outcome is unflattering, at least it will be a true picture and not a hastily taken snapshot. Sadly, existing inspections don’t take into account variables such as agency budgets, staff shortages and bed occupancy. How many failures result in closure? No matter how badly hospitals fare, they always seem to scrape a pass. Ask any patient who regularly visits a hospital if inspections have made a positive difference to them and they’ll probably reply: ‘Only if I’m admitted on inspection day.’

Simon Daniels is a mental health rehabilitation nurse in Stoke-on-Trent

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