The Care Quality Commission (CQC) has published its analysis of the quality and safety of care provided by independent acute hospitals across England
Having inspected and rated 206 independent acute hospitals in England, the CQC has found that, overall, ‘the majority of independent acute hospitals are providing high-quality care for their patients’.
Evaluating how ‘safe’, ‘caring’, ‘effective’, ‘responsive to people’s needs’ and ‘well led’ they are; as of January 2, 2018, 62% were rated as good and eight per cent outstanding.
The analysis also showed that most patients have ‘prompt access to effective treatment’ and experience ‘personalised care from highly skilled and caring staff’.
Eight-nine per cent of the hospitals inspected were rated as good and 11% were rated as outstanding for how ‘caring’ their services were; 86% were rated as good and seven per cent as outstanding for how ‘responsive’ they were.
Also noted was that patients were ‘more likely’ to have a named consultant and the hospitals managed their flow of patients well – which, the CQC says, meant fewer cancellations or delayed admissions or procedures.
Room for improvement
Howver, there is room for improvement. Thirty per cent of hospitals were rated as requires improvement and three per cent as inadequate for how well-led they were.
Safety was where CQC had the greatest concerns – 41% of hospitals were rated as requires improvement and one per cent as inadequate in this area.
In some cases, CQC found that a lack of formalised governance procedures meant that hospitals were not effectively monitoring the work of consultants who operate under ‘practising privileges’ – where a consultant clinician works in a hospital but is not a direct employee. Checks to ensure clinicians were only working within their agreed scope of practice were not always taking place. This meant that there was a risk that poor practices were not always picked up or challenged in the way they should be.
Inspectors also saw that safety procedures were not always fully embedded – for example, where surgeons were not following every step of the World Health Organisation surgical checklist.
Other issues highlighted by CQC include a failure by some hospitals to adequately monitor clinical outcomes to evaluate the effectiveness of the services they were providing, and a lack of preparation for the possibility that a patient’s condition could deteriorate.
CQC has used its inspections and ratings to help independent acute hospitals understand the specific areas where improvements are needed, to hold them to account to make the necessary changes, to share best practice and to help people to make more informed choices about their care.
Already, CQC’s actions are driving improvements in care for people and providers have been quick to respond to inspection findings taking on board CQC’s judgements and proactively addressing areas where further work is needed to improve patient care. Of the 13 hospitals that had been re-inspected, seven had improved. Four of these had improved from an initial rating of inadequate: two going from inadequate to good and two going from inadequate to requires improvement.
Independent acute hospitals provide a range of services including surgery, diagnostics and medical care. With many independent hospitals providing services that are funded partly or in full by the NHS, they are playing an increasingly important role in delivering healthcare services in England.
CQC introduced its new comprehensive inspection programme for independent acute hospitals in 2015. This saw the start of expert-led, specialist inspections that focussed on what matters most to people using services – whether they are safe, caring, effective, responsive and well-led – as well as the introduction of performance ratings of ‘outstanding’, ‘good’, ‘requires improvement’ and ‘inadequate’ to help people make informed choices about their healthcare.
The findings from these inspections have helped to inform CQC’s plans to further develop its approach to regulation for all independent healthcare services.