Staffing levels at independent acute hospitals are generally good but a review of provision by the Care Quality Commission has found not all nurses have the specialist skills they need.
A CQC report on the quality and safety of provision at the more than 200 independent acute settings it has inspected found most were providing good care, with 70% rated “good” or “outstanding”.
“There were some examples where nurses lacked specialist knowledge required to care for all patients on their ward”
However, it also identified “clear scope for improvement”, given that nearly a third – 30% – of the providers that it looked at in England were currently rated as “requires improvement”.
When it came to staffing levels, CQC inspectors found that independent hospitals had not been affected by the kind of nursing shortages seen in the NHS.
“Our inspections showed that there were not the same staffing issues in independent acute healthcare as in other sectors, such as shortages and high turnover,” said the CQC’s report – titled The state of care in independent acute hospitals.
“This meant that patients received a good continuity of care. Staff morale was generally good, and this had a positive impact on the care that people received,” it said.
“We saw a few instances where the WHO surgical checklist was not being followed rigorously”
However, the report goes on to identify a lack of expertise among some nursing staff. “While staffing numbers were generally good, there were some examples where nurses lacked specialist knowledge required to care for all patients on their ward,” said the report.
The report highlighted safety as a particular concern, with 41% of hospitals rated as “requires improvement” and 1% rated “inadequate” in this area.
In some cases, CQC inspectors found “a lack of a culture of learning from incidents and a weakness around incident reporting”.
Other issues identified included a failure by some hospitals to monitor clinical outcomes in order to evaluate the effectiveness of the services they provide.
Surgical services tend to be the main focus in independent, non-specialist acute hospitals and the report found the quality of care in surgery was “generally good”, with 68% of services rated as “good” and 6% “outstanding” as of January 2018.
“We now have a comprehensive picture of the quality of care they are providing for the first time”
The report said: “This is where providers’ experience lies, and there is a large throughput of routine operations and procedures.
“In ‘good’ and ‘outstanding’ services surgeons are skilled, having completed the same procedures many times. They are supported by experienced, specialist surgical nurses,” it said.
However, inspectors also found “risks in operating theatre safety due to informal practices and consultant behaviour”.
“For example, we saw a few instances where the World Health Organization surgical checklist was not being followed rigorously and this was not always sufficiently challenged by staff within the operating theatre,” said the report.
“There was a lack of preparedness for patients whose condition could deteriorate,” it said. “This is a necessity, even where pre-assessment screening has ensured that the majority of patients are ‘well’ and fit for surgery.”
“Providing safe and high-quality care for patients is the top priority for independent hospitals”
One issue identified by the CQC was a lack of formalised governance procedures, especially when it came to oversight of consultants working under “practising privileges” – where hospitals provide the facilities and nursing support and the consultants are granted the right to practise there.
“The lack of robust and effective oversight of practising privileges, and a focus of providers treating consultants as ‘customers’ bringing business to the hospital, meant that providers could be reluctant to challenge them,” said the report.
“It is essential that providers demonstrate that they are proactively auditing and monitoring consultants’ work, and have real oversight of services in order to protect patients and ensure they are being treated safely and effectively,” it said. “In many cases they could not.”
Such concerns about governance were reflected in the fact 30% of independent acutes were rated as “requires improvement” – and 3% as “inadequate” – for leadership.
edward ted baker
The CQC’s chief inspector of hospitals, Professor Ted Baker, said that where governance was poor it was often “viewed as the responsibility of individual clinicians, rather than a corporate responsibility supported by formal governance processes”.
He said the fact the CQC had now inspected all independent acute hospitals in England meant “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,” he added. “We want to see this continue and more providers learning from those services that are getting it right.”
Dr Howard Freeman, clinical director at the NHS Partners Network, said the report showed that independent acute hospitals played “a significant role in delivering caring and responsive services for both NHS and private patients”, and were quick to respond to any issues raised by inspectors.
“Providing safe and high-quality care for patients is the top priority for independent hospitals and this important report from the CQC demonstrates the safety and quality of services being delivered, supporting patients to make the best choices about their own care,” he said.
He added: “Where the CQC has identified areas for further improvement in independent hospitals it is encouraging that it has found that ‘providers have been quick to respond to inspection findings’, with over half of the independent acute hospitals re-inspected improving their rating.”