“Urgent” improvements to the way inspectors assess compliance with the new duty of candour law have been called for, following analysis that revealed the Care Quality Commission is failing to provide adequate details on the regulations in a quarter of its reports on hospitals.
Patient charity Action against Medical Accidents found that from a sample of 90 CQC reports from hospital inspections in 2015, 7% did not refer to the law at all and 19% were “superficial” in how they dealt with the regulations.
“There did not appear to be any standardised guidance on what evidence inspectors should seek”
Action against Medical Accidents
A “moderate” degree of analysis on the law’s implementation was found in 61% of reports and 13% provided detailed findings on trust compliance.
But while 34 reports contained criticism of how the NHS trust was implementing the law, only 14 of these went on to make a recommendation about how to improve the organisation’s compliance.
The law was introduced in November 2014 following a recommendation by the 2013 Francis report into care failings at the former Mid Staffordshire Foundation Trust.
It places a legal duty on hospital, community and mental health trusts – and more recently GPs and all other providers registered with the CQC – to inform and apologise to patients if there have been mistakes in their care that have led to significant harm.
“Having fought so hard to get a statutory duty of candour, we are deeply disappointed about how the CQC has regulated this so far”
Action against Medical Accidents said it was “disappointed” and “surprised” that in the first year of the law’s introduction the CQC had taken an inconsistent and superficial approach to its assessment.
It said it was “totally unacceptable” that six inspections “paid no attention at all to the duty of candour”.
“We appreciate the huge task that the CQC has in inspecting all registered providers and monitoring compliance with all standards. It would be unrealistic to expect inspection reports to contain a detailed analysis of implementation of or compliance with every standard,” said the charity.
“However, the large number of reports assessed as ‘superficial’ in this regard (19%) is also very disappointing,” it said in its report Regulating the duty of candour.
The charity also noted inspections were heavily reliant on comments from trusts about how they had implemented the law.
“Whilst some reports mention seeing examples of implementation, we could not find any inspection report that included independent analysis of a random selection of incidents,” it said.
“The approach across the inspections was inconsistent. There did not appear to be any standardised guidance on what evidence inspectors should seek,” said the charity’s report.
The charity called for “urgent” improvements to the way the CQC regulated duty of candour regulations.
It made a series of recommendations including that the CQC use a more robust and consistent method of assessing compliance with the candour law, as well as more in-depth analysis of why organisations may not be adhering to the regulations and suggestions for improvement.
Charity chief executive Peter Walsh said: “Having fought so hard to get a statutory duty of candour, we are deeply disappointed about how the CQC has regulated this so far.
“We still believe the duty of candour is potentially the biggest breakthrough in patient safety and patient rights in modern times, but we have always said that its success will depend to a large extent not only on the goodwill of providers, but on robust regulation by the CQC,” he said.
“We have developed our methodology [and] this is now allowing us to follow a more robust and consistent approach in assessing the regulation”
He added: “The public have a right to expect that the CQC gives this fundamental standard the priority it deserves, and for it to be seen to be doing so, if we are to move from a situation where dishonesty and cover ups are simply frowned upon to one where they are no longer tolerated.”
The CQC said it welcomed the charity’s report and that in the first year since the law had been introduced it had focussed on trusts’ awareness and the systems and processes in place to support its implementation.
It said it had since developed its methodology to ensure a more consistent approach to assessing compliance with the duty of candour regulations and would be applying this to future inspections.
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Professor Edward Baker, CQC deputy chief inspector of hospitals, said: “From these early inspections we identified the need for a more systematic approach to inspecting how well organisations are embedding the duty as part of their broader approach to learning from incidents and supporting people who use services and their families.
“We have since developed our methodology with input from Action Against Medical Accidents, and this is now allowing us to follow a more robust and consistent approach in assessing the regulation as part of our hospital inspections,” he said. “We will soon be rolling this out across all sectors.”