1. The new CQC approach to hospital inspection
Ann Ford
Head of Hospital Inspection (North West) 1 1

2. Our purpose Our role Our purpose and role
We make sure health and social care services provide people with safe, effective, compassionate, high-quality care and we encourage care services to improve
Our role
We monitor, inspect and regulate services to make sure they meet fundamental standards of quality and safety and we publish what we find, including performance ratings to help people choose care 2

3. Our New Approach Is it safe? Is it effective? Is it responsive?
We ask these questions of all services:
Is it safe?
Is it effective?
Is it responsive?
Is it caring?
Is it well led? 3

4. The new CQC hospital inspection programme
We have retained the positive elements of our earlier approach in particular in relation to rigorous evidence gathering.
We have built on the Keogh Reviews process for 14 acute hospitals with high mortality.
We aim to be robust, fair, transparent and (hopefully) helpful.
Work with partners to secure improvement.

5. The new approach: Acute hospital inspections
3 Phases:
Pre-inspection: Development of data pack Recruitment of team
Inspection: 8 core services , less for specialists key questions Large team: Around 30 people. Visits to clinical areas + focus groups, listening events and interviews
Post inspection: Report writing Confirmation of ratings Quality Summit

6. Core Services
There are 8 core services for Acute Hospitals A&E Medical Care Surgical Care & Theatres Critical Care Maternity & Family Planning Children and Young People’s Care End of Life Care Outpatients

7. Core Services Mental Health
Acute wards
Psychiatric intensive care units (PICUs)
Long stay / rehabilitation wards
Health-based places of safety
Forensic inpatient / secure wards3
Child and adolescent mental health services (CAMHS)
Services for older people
Services for people with learning disabilities or autism
 Adult community-based services
Community-based crisis services
Specialist eating disorder services
Other specialist services

8. Data packs
We collate as much information as possible on the 5 key questions and 8 core services
Examples include:
Safety: STEIS; NRLS; infection rates; safety thermometer
Effectiveness: Mortality (HSMR/SHMI); National Clinical Audits
Caring: CQC Inpatient Survey; Friends + Family Test
Responsiveness: Waiting times; Cancellations; Discharges
Well led: Staff survey; Staff sickness rates, Governance

9. Differences in the Methods
 Differences in inspection methods.
In mental health due to the restrictions placed on patients who are detained the larger listening type event are replaced with targeted  involvement from community groups. We also run patient focus groups and drop in sessions to ensure that we are able to capture the views of people who use services.
We include Mental Health Act monitoring visits as part of the comprehensive inspection and there are sections in the report that cover our finding of adherence to the Mental Health and Mental Capacity Acts.

10. CQC’s 5 key questions
Safe? Are people protected from abuse and avoidable harm? Effective? Does people’s care and treatment achieve good outcomes and promote a good quality of life, and is it evidence- based where possible? Caring? Do staff involve and treat people with compassion, kindness, dignity and respect? Responsive? Are services organised so that they meet people’s needs? Well-led? Does the leadership, management and governance of the organisation assure the delivery of high-quality patient- centred care, support learning and innovation and promote an open and fair culture?

11. Inspection Teams Chair Team Leader Doctors (senior and junior)
Nurses (senior and junior)
AHPs/Managers
Experts by experience (patients and carers)
CQC Inspectors
Analysts
Programme management support

12. Rationale for ratings
The public and patients want information about the quality of services presented in a way that is easy to understand
The approach taken by Ofsted is seen as a model, though we recognise that hospitals are more complex than schools.
Patients/public may, for example, be interested in a particular service (e.g. Medicine, surgery) rather than a single global rating
Ratings of services and of Trusts should hopefully be a driver for improving services and patient outcomes.

13. Ratings: Approach A four point scale will be used for all ratings
Outstanding
Good
Requires Improvement
Inadequate
Ratings will always take account of all sources of information
Intelligent monitoring tool
Information provided by Trust
Other data sources and intelligence e.g. CCGs
Findings from site visits
Direct observations
Staff focus groups
Patient and public listening events
Interviews with key people

14. Ratings: Approach
Bottom up approach: Rate each of the core services on each of the five key questions (safe, effective, caring, responsive, well led).
Then rate the Trust as a whole on the five key questions, including an overall assessment of well led at Trust level.
Derive a final overall rating.

15. Intensive/critical care Maternity & family planning
Ratings Grid
Safe
Effective
Caring
Responsive
Well-led
Overall
Accident & Emergency RI
NSE G
Medical care
Surgery
Intensive/critical care
Maternity & family planning
Children's care
End of Life
Outpatients

16. Summary The new approach is a major change
Our evidence is that hospitals have already made improvements as a result of these inspections
The process is dynamic and we are open to feedback and suggestions
We are committed to continuous improvement

17. Thank you for your time
Any Questions ?