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NHS watchdog concerned over care and safety at one in four hospitals NHS watchdog concerned over care and safety at one in four hospitals
(about 11 hours later)
NHS Trust risk ratings
Band 1 is considered the highest risk and band 6 the lowest
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One in four NHS hospitals is a cause for concern over the quality or safety of the care it provides to patients, the service's statutory watchdog has warned.One in four NHS hospitals is a cause for concern over the quality or safety of the care it provides to patients, the service's statutory watchdog has warned.
In an analysis of all 161 acute hospital trusts in England that is the most comprehensive ever carried out, the Care Quality Commission (CQC) says it is worried about aspects of care at 44 (27.3%) of them. In an analysis of all 161 acute hospital trusts in England – the most comprehensive ever carried out – the Care Quality Commission (CQC) says it is worried about aspects of care at 44 (27.3%) of them.
Performance in some areas is so inadequate that it poses a risk or an elevated risk to patients.Performance in some areas is so inadequate that it poses a risk or an elevated risk to patients.
The sheer number of hospitals about which the regulator is concerned dwarfs the 14 trusts that Professor Sir Bruce Keogh, the NHS's medical director, investigated earlier this year. Eleven of those 14 were put into special measures as a result of inadequacies he uncovered.The sheer number of hospitals about which the regulator is concerned dwarfs the 14 trusts that Professor Sir Bruce Keogh, the NHS's medical director, investigated earlier this year. Eleven of those 14 were put into special measures as a result of inadequacies he uncovered.
The CQC examined 150 national, NHS-wide measures of quality and safety of care in a new assessment system it calls "intelligent monitoring".The CQC examined 150 national, NHS-wide measures of quality and safety of care in a new assessment system it calls "intelligent monitoring".
It then put all 161 trusts into one of six bands, each of which includes those deemed a higher or lower risk, on the basis of the evidence.It then put all 161 trusts into one of six bands, each of which includes those deemed a higher or lower risk, on the basis of the evidence.
CQC analysts have assigned the trusts into the bands – one is the most worrying and six the least – on the basis of how well they were doing judged by many criteria. There are 24 trusts in band one and 20 in band two, which are the only two categories the CQC is concerned about. Intelligent monitoring will guide the regulator in deciding which hospitals to inspect most urgently.CQC analysts have assigned the trusts into the bands – one is the most worrying and six the least – on the basis of how well they were doing judged by many criteria. There are 24 trusts in band one and 20 in band two, which are the only two categories the CQC is concerned about. Intelligent monitoring will guide the regulator in deciding which hospitals to inspect most urgently.
The 24 include the 11 trusts in special measures, those that are already being investigated by the CQC's much more in-depth and forensic inspection regime it has developed after the Mid Staffordshire hospital care scandal, and some of the next 19, which it will inspect from January. The 24 include the 11 trusts in special measures, those that are already being investigated by the CQC's much more in-depth and forensic inspection regime which it has developed after the Mid Staffordshire hospital care scandal, and some of the next 19, which it will inspect from January.
The criteria include waiting times for treatment in A&E, after referral by a GP and for cancer; patients' trust in the doctors and nurses; rates of hospital-acquired infections and stroke patients scanned within an hour of arrival; patient safety incidents and "never" events (incidents such as amputating the wrong limb that should never happen); management of patients' pain; and how much help was provided to someone to help them eat their meal.The criteria include waiting times for treatment in A&E, after referral by a GP and for cancer; patients' trust in the doctors and nurses; rates of hospital-acquired infections and stroke patients scanned within an hour of arrival; patient safety incidents and "never" events (incidents such as amputating the wrong limb that should never happen); management of patients' pain; and how much help was provided to someone to help them eat their meal.
The CQC calls these "smoke detectors", which help alert them to hospitals that are outside the expected range of performance in a particular area, which also include several types of mortality rates.The CQC calls these "smoke detectors", which help alert them to hospitals that are outside the expected range of performance in a particular area, which also include several types of mortality rates.
Taking trusts' scores in those 150 areas, it has categorised band one as including those at which performance is 7.5% below the norm. Band two contains trusts at 5.5% below the norm, at band three it is 4.5% below (31 trusts), at band four it is 3.5% below (25 trusts) and in band five it is 2.5% below (24 trusts). By contrast, there are 37 trusts in band six, where performance is typically 2% above the norm.Taking trusts' scores in those 150 areas, it has categorised band one as including those at which performance is 7.5% below the norm. Band two contains trusts at 5.5% below the norm, at band three it is 4.5% below (31 trusts), at band four it is 3.5% below (25 trusts) and in band five it is 2.5% below (24 trusts). By contrast, there are 37 trusts in band six, where performance is typically 2% above the norm.
The Patients Association said the CQC's concerns about the 44 trusts were hugely worrying but also not a major surprise, given the evidence it collects about poor care and safety breaches.The Patients Association said the CQC's concerns about the 44 trusts were hugely worrying but also not a major surprise, given the evidence it collects about poor care and safety breaches.
"It's hugely worrying that there's such a high number of trusts where the CQC has concerns about the quality and safety of the care being delivered. But it doesn't come as much of a surprise because we know from our work that elements of poor care are widespread in the NHS," said Katherine Murphy, the charity's chief executive, who is an ex-NHS nurse and manager."It's hugely worrying that there's such a high number of trusts where the CQC has concerns about the quality and safety of the care being delivered. But it doesn't come as much of a surprise because we know from our work that elements of poor care are widespread in the NHS," said Katherine Murphy, the charity's chief executive, who is an ex-NHS nurse and manager.
"We don't think there's any hospital that's providing 100% high-quality, safe care. Calls to our helpline tell us that things like misdiagnosis, cancelled operations and poor care in hospital, especially elderly patients not being cared for with the compassion and dignity they deserve, happen frequently in hospitals all over the country. This problem is so endemic in the NHS," she added."We don't think there's any hospital that's providing 100% high-quality, safe care. Calls to our helpline tell us that things like misdiagnosis, cancelled operations and poor care in hospital, especially elderly patients not being cared for with the compassion and dignity they deserve, happen frequently in hospitals all over the country. This problem is so endemic in the NHS," she added.
Professor Sir Mike Richards, the CQC's chief inspector of hospitals, told the Guardian: "This information highlights the hospitals where we have potential concerns about the quality and safety of services. Our greatest concerns focus on the 24 trusts in band one, which we have prioritised for inspections."Professor Sir Mike Richards, the CQC's chief inspector of hospitals, told the Guardian: "This information highlights the hospitals where we have potential concerns about the quality and safety of services. Our greatest concerns focus on the 24 trusts in band one, which we have prioritised for inspections."
Richards, a distinguished oncologist and ex-cancer tsar, used a medical analogy to convey the purpose of the new intelligent monitoring system.Richards, a distinguished oncologist and ex-cancer tsar, used a medical analogy to convey the purpose of the new intelligent monitoring system.
"As a doctor, I liken intelligent monitoring to a screening test. Our inspection, combined with intelligent monitoring, provides the diagnosis, following which we make a judgment, which in turn leads to action," he explained."As a doctor, I liken intelligent monitoring to a screening test. Our inspection, combined with intelligent monitoring, provides the diagnosis, following which we make a judgment, which in turn leads to action," he explained.
Matt Tee, chief operating officer of the NHS Confederation, which represents hospitals, said the CQC's use of 150 measures of performance had helped it devise "a robust process for identifying which organisations should be prioritised for external inspection".Matt Tee, chief operating officer of the NHS Confederation, which represents hospitals, said the CQC's use of 150 measures of performance had helped it devise "a robust process for identifying which organisations should be prioritised for external inspection".
However, he urged the regulator to use in its monitoring only information that is already available, in order not to divert valuable staff time and resources away from patient care.However, he urged the regulator to use in its monitoring only information that is already available, in order not to divert valuable staff time and resources away from patient care.
NHS Trust risk ratings Lisa Jordan, national head of medical negligence at law firm Irwin Mitchell, said the CQC's finding were very worrying.
Band 1 is considered the highest risk and band 6 the lowest
Click column heading to sort 		"Every effort must now be made to assess the findings of the CQC's analysis to consider what steps can be taken to ensure that standards of safe, quality care are offered across the entire NHS," she said.
"Patient safety must be at the heart of all changes made to the NHS and a strong reaction to this study is needed to rebuild public confidence and trust following a difficult few months for the service."
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