The hospital inspector: Sir Mike Richards
The Care Quality Commission aims to inspect all hospitals in England by December 2015. Sarah Kidner talks to the man in charge. Plus, you can listen to parts of the interview.
“I wouldn’t be doing this if it was just about inspecting, if I didn’t believe inspection would lead to better care,” says Professor Sir Mike Richards, Chief Inspector of Hospitals for the Care Quality Commission (CQC). His task is to inspect all the hospitals in England, NHS and private, by December 2015.
It’s a big job, which involves collecting a lot of information before anyone sets foot in a hospital. “We gather as much information as we can from national data, clinical commissioning groups, and by asking the local public what they think,” says Sir Mike. “The more we know before we go into the hospital, the more we can know when we are there.”
The CQC continuously monitors hospitals using an intelligent monitoring tool that tracks around 150 different factors. “In terms of safety, we have things called ‘never events’ that should never happen but do from time to time; if there are too many of those, or too many infections at a hospital, that triggers a score. We wouldn’t make a judgement based on that, but a high score would tell me there’s something of concern and that we need to make an inspection sooner rather than later,” says Sir Mike.
Before an inspection, the CQC assembles a team of junior and senior doctors and nurses, patients and carers who we call “experts by experience”, and CQC inspectors. “We have defined some services we will always look at: the A&E, the medical wards – including elderly care wards – the surgical wards and the operating theatres, critical care, maternity, children’s care, and end of life care and outpatients.
We’re trying to look at what’s good as well as what’s not good in a hospital
“That’s not all we do. While we’re on site, we also hold focus groups and we listen to the consultants, the sisters, the junior doctors, the junior nurses, other health professionals and all sorts of different people.
“We also always hold a public listening event, which we announce well in advance so that people can come. It’s usually held early evening at the beginning of our inspection, and we expect to hear mixed views. We will get people who’ve had very good experience, we’ve also hear from people who have not. Those can help us to know where to go in a hospital.
“As far as possible, we want to get a rounded view. It’ very important to say is that we’re trying to look at what’s good as well as what’s not good in a hospital.”
Equality of care
Consistency is paramount, says Sir Mike, who has taken a hands-on approach to inspections.
“In the first wave of inspections between September and December , I absolutely committed that I would go to at least one day of each of the 18 inspections and for one of the inspections I led it from start to finish.
“I really wanted to see if it was possible to get the data pack that we have and then go into a hospital and, at say at the end of three days, really have a view about what is going on in that hospital. I have led two of those inspections now and the answer is to a large extent ‘yes’. Do I know every detail of that hospital by the end of that three day period? No. But I have got a really good idea because we’re hearing from so many different angles about what’s going on.
Each service within hospitals is assessed according to five key questions: is it safe, is it caring, is it responsive, is it set up to meet the needs of patients and is it well led?
“Inspecting is part of my job, and making sure inspection teams are trained, and that we have an absolutely fair approach - which does not mean a tick-box approach. We need to be confident that if we send two different teams into the same hospital, they would come out with the same verdict, and we’re being fair between hospitals.”
“Each service within hospitals is assessed according to five key questions: is it safe, is it caring, is it responsive, is it set up to meet the needs of patients and is it well led?
“Ultimately, the CQC will rate all hospitals and services on a four-point scale; is it outstanding, is it good, does it require improvement or is it inadequate?
“We have been into about 20 hospitals so far using the new methodology and I think we are seeing a lot of good care. We are able to distinguish between some hospitals that are generally doing better and some hospitals that are generally doing less well. But, equally, it’s not as simple as that. It may be that a hospital is doing very well in terms of one service – such as maternity – but is doing less well in another service - maybe the A&E department – or it may be the other way around.
“We can reflect that back to the hospital and tell the hospital where we expect them to improve. There’s a mixture. There are some services that are working very well, some that are working not so well, even some individual wards that might not be working as well, but we can say people need to improve and that we will be back to re-inspect.
Sir Mike says that the CQC does get contacted by whistleblowers, and that it can protect their anonymity. He says this may lead to an inspection either of a specific part of the hospital, or for the CQC to look more generally at how the hospital manages concerns and whether it has a culture of openness.
We always listen to people who whistle-blow to us
He says: “The staff survey is a pretty good guide. We ask ‘Do you feel you have been bullied or harassed in the last year?’ We are taking this very seriously.
“We always listen to people who whistle-blow to us.”
Sir Mike believes good hospitals have an open culture and act on complaints from patients or concerns raised by staff. But he acknowledges: “That is not where we are in every hospital in the country and we do know that people sometimes have difficulties getting their concerns heard, and in some cases haven’t been treated well when they have raised concerns.
Protecting the vulnerable
Looking at how hospitals care for vulnerable groups, such as people with dementia or with learning disabilities, is a key part of CQC inspections, says Sir Mike.
“I believe you can’t call a hospital outstanding if it isn’t caring well for vulnerable groups; that’s why we will always be asking those questions.”
The CQC is working with organisations for people with learning disabilities, and patient and carer inspectors often also are able to reflect the interests of vulnerable groups.
We’ve seen some fantastically compassionate and committed staff in every hospital we’ve been to
The CQC doesn’t just cover hospitals – it also covers most areas of health and social care, from GP surgeries to adult social care. Sir Mike says: “We all work closely together. When we look at hospitals we want to know how well the hospital is integrating with primary care, so we want to hear the views of GPs.
“If GPs are sending patients to the hospital what do they think of it; do they ever get letters back from the hospital? How good is the communication; how rapidly can they get access to expert advice if they want it?
“Also, as patients come out of hospital hospitals need to be integrated with social care to make sure that people can be discharged and got home when they need to be.
“We’re learning the right questions to ask. We need to build those in when we’re inspecting GPs when we’re inspecting hospitals, when we’re inspecting social care, community trusts and all of those.
Sir Mike is keen to point out that they’ve witnessed some good quality care, and that hospital staff are keen to improve. “There is a huge desire from everyone working within the hospital sector to be delivering good care. Nobody goes to work saying they’re going to deliver anything other than good care. We know, already, that the hospitals we have been to are responding. I am confident that we will see improvements as a result of this.
“People ask ‘is compassion in quality of care a thing of the past?’. Absolutely not, we’ve seen some fantastically compassionate and committed staff in every hospital we’ve been to.”
Read our guide to who does what in hospital, and how you can make the most of them
Find out more
CQC is seeking feedback from the public about its new approach to inspecting health and adult social care services in England through a series of events and online. To keep up to date with the latest developments, follow CQC on Twitter or visit the Care Quality Commission website.
CV Professor Sir Mike Richards
1986 - 1995 Consultant medical oncologist
1995 - 1999 Professor of Palliative Medicine, Guy’s and St. Thomas’ Hospitals.
1999 - Appointed National Cancer Director, Department of Health
2007 - Role extended to incorporate end of life care
2012 - Director for Reducing Premature Mortality, NHS Commissioning Board (now NHS England) where he led the development of a cardiovascular outcomes strategy