The CQC has recently issued a report, ‘The state of care in independent acute hospitals’, summarising findings from its programme of comprehensive independent acute inspections.
The report recognises there is a continuing growth of independent healthcare providers delivering surgical procedures, elective care and providing components of services in NHS Trusts. The report reiterates that all providers of healthcare will be held to the same standards regardless of how they are funded.
The CQC inspected and rated 206 hospitals, the CQC found most patients had prompt access to effective treatment and experienced personalised care from highly skilled staff. The CQC found evidence of good and outstanding care in relation to:
- Staff interaction with patients
- Effective treatment
- Local leadership
The majority, 62%, were rated as ‘good’, with surgery, outpatients and diagnostic imaging services found to be performing well overall.
However, 30% of the hospitals inspected were rated as ‘requires improvement’. It is reported that services for children and young people in particular need to improve with 38% being rated as ‘requires improvement’ and 3% as ‘inadequate’.
The CQC reports concerns around the safety in some services, often as a result of a lack of checks and/or poor monitoring of risk. Too often safety was viewed as the responsibility of individual clinicians rather than a corporate responsibility.
In many cases the concerns expressed by the CQC related to the quality and effectiveness of the governance at the hospital. The report suggests that many providers did not have formal governance processes in place and instead tended to rely on informal arrangements based on longstanding relationships – of people ‘knowing each other’ and assuming all was well. In such circumstances there is a real danger that poor practices are not identified or challenged as required.
In summary, CQC’s concerns related to:
- Lack of oversight and effective monitoring of the work of consultants operating under practising privileges, compounded in some cases by the informality of some Medical Advisory Committees
- Poor and inconsistent monitoring of risks, and
- Absence of systematic processes to underpin a culture of learning from risks
The CQC reports that there needs to be a substantial improvement by a number of providers in terms of auditing, reporting and benchmarking outcomes. The CQC notes that some providers were not collecting their own outcome data, in part due to an expectation that consultants were monitoring their own outcomes. The report notes that providers need to maintain financial viability and profitability in a way which is somewhat different to the NHS and the competitive nature of the sector creates incentive for providers to be less transparent regarding outcomes and slow to share information in the interests of encouraging improvement across all services.
Risks were also identified in operating theatres due to informal practices and consultant behaviour. There was a lack of preparedness for patients whose condition could deteriorate, which is a necessity even where pre-assessment screening has ensured that majority of patients are fit for surgery.
A poor governance culture is often the source of criticism by the CQC when inspecting hospitals and care homes. It is easy to see how this can arise where many of the clinicians are independent contractors working at the hospital as a result of ‘practising privileges’. The CQC has been clear that it is the provider who is providing the care and as such it needs to be assured and able to evidence how the care being provided is safe and appropriate.
However, if the governance is not robust, there are clear patient safety issues that arise, and thus regulatory problems as far as the CQC is concerned.