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King’s Fund: ‘Improve patient involvement in care’

The NHS watchdog Care Quality Commission (CQC) has expressed concern over the quality of care provided to patients in 44 out of 161 acute hospital trusts in England. It is a significant increase on previous figure of 14 previously reported by Professor Sir Bruce Keogh, NHS Medical Director.
The CQC has grouped the 161 trusts into six bands to determine which hospitals require monitoring most urgently. Band one is the most worrying and band six is the least. The CQC is concerned with the first two bands.  Twenty four trusts have been rated as band one with 20 trusts included in band two.
The CQC calls these bands ‘smoke detectors’, which helps them to highlight hospitals which were outside the expected range of performance in a particular area. The banding will not be used as a final rating, but as a screening tool for inspections. This monitoring exercise is part of a new hospital inspection regime, which will see inspectors inspecting every trust by 2015. The first wave of inspections started in September and it is expected that the first 18 inspections will have taken place by Christmas 2013.
The inspection criteria include rates of hospital –acquired infections; patients’ trust in the medical staff, as well as waiting times for treatment in A&E. It will result in every trust being given a rating of either ‘outstanding’, ‘good’, ‘requires improvement’ or ‘inadequate’ as part of a shake-up in the system ordered after the Stafford Hospital scandal.
The trusts are scored in 150 areas with the ratings described as follows:

  • Band one covers trusts rated at 7.5% below the normal standards of performance
  • Band two are 5.5% below
  • Band three ratings are 4.5% below (31 trusts)
  • Band four ratings are 3.5% below (25 trusts)
  • Band five ratings are 2.5% below (24 trusts)

By contrast, there are 37 trusts in band six, with performance typically deemed to be 2% above the norm.
The Patients Association described the CQC’s concerns about the 44 trusts as hugely worrying but also not a major surprise, given the evidence it collects about poor care and safety breaches.
Katherine Murphy, Chief Executive of the Patients Association, said: “It’s hugely worrying that there is 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.
“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,”
Professor Sir Mike Richards, the CQC’s chief inspector of hospitals, has said “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.”

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