The Care Quality Commission has warned trusts not to try and “play the system” to improve their inspection ratings at the expense of dealing with concerns, following an email from a chief nurse.
The senior nurse has apologised after it was revealed she had sent an email suggesting part of the regulator’s fact checking process could be used to influence the provisional ratings given to her trust.
“It could suggest a worrying fixation on external reputation at the expense of resolving and being honest about genuine concerns”
The so-called “factual accuracy process” is described by the CQC as an opportunity to “challenge the accuracy and completeness” of information in its draft inspection report on which ratings are based.
The provider in question, Aintree University Hospital NHS Foundation Trust, was inspected in October and rated as “requires improvement” in a draft report sent to the organisation this month, which would represent a fall from its previous overall CQC rating of “good”.
“It is fair to say that we are disappointed about the outcome,” said trust chief nurse Diane Brown in a confidential email sent to senior consultants and directors, according to the Health Service Journal.
“[We] are actively exploring, as part of the factual accuracy work, whether we might be able to influence the ratings of individual areas which might have a bearing on our overall rating of requires improvement,” she said.
“Although the report identifies a myriad of minor issues… these are areas we are already aware of and working on to address,” she wrote.
Ms Brown said responses to the CQC needed to be in terms of factual accuracies and extra information should be provided to support any corrections.
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She added: “As discussed, we ideally would need to move one of the [requires improvement] outcomes in either well led or safe to achieve an overall outcome of good.”
Her message also stated that it was “not appropriate to share this email, its content or any of the draft report findings with colleagues” before the ratings and report were finalised.
But a colleague, who subsequently showed the email to the Health Service Journal, claimed the message was an inappropriate attempt to encourage staff to try to get the CQC to change ratings.
Meanwhile, CQC chief inspector of hospitals Ted Baker warned trusts that attempted “to play the system and try to improve their provisional ratings” were likely to fail.
Such attempts could also indicate that a trust had a “worrying fixation” on its external reputation at the expense of identifying and dealing with “genuine” care concerns, he noted.
Professor Baker highlighted that the factual accuracy process was intended to allow trusts to challenge draft reports, so that patients had reliable information about services.
He said he welcomed corrections when errors had been made and also backed involving staff in the factual accuracy process. But he warned that engaging staff “purely as an attempt to play the system and try to improve their provisional ratings” suggested a “fundamental misunderstanding” of its intended aim.
“Our process is very rigorous and we do not change our draft inspection reports unless we have clear evidence that there is a reason to do so,” he added.
“My intention in this was to ensure that the final report is as accurate as possible”
In a statement, Ms Brown said the trust had an open culture and had already “fully accepted” the feedback from inspectors, and that the CQC had accepted the trust’s action plans.
She said: “I included in that email the factual details of how the CQC develop their ratings, based on the CQC guidance, which is freely available on the CQC website and which can be seen by anyone.
“My intention in this was to ensure that the final report is as accurate as possible because that is what we base our improvement work on,” she said. “I would certainly apologise if someone believed that was inappropriate.”
She added: “Our service leads have reported a number of inaccuracies in the draft and we will be feeding those comments and evidence back, as planned, on Tuesday 23 January, after which we will await publication of the final report.”