Trusts face annual CQC inspections under tougher regime

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The Care Quality Commission is planning to inspect each NHS trust at least once a year, in a significant shift away from “risk based” regulation.

In an interview with HSJ, CQC chief executive Cynthia Bower admitted the number of inspections had “completely collapsed” due to the pressures of launching the registration system last April.

She said the abuse suffered by learning disability patients in the recent Winterbourne View case, in addition to feedback from staff and patient groups, had demonstrated more inspections were needed.

The decision also follows criticism from MPs on the Commons health committee and witnesses at the public inquiry into Mid Staffordshire Foundation Trust about the lack of on-the-ground checks.

Ms Bower said she wanted inspectors to “cross the threshold” of each NHS trust, independent provider and adult social care organisation, unannounced, at least annually.

She said: “Where people’s lives are at stake, wellbeing is at stake, [the public] don’t want to hear about light touch regulation. They want to believe that, informed by the best professional practice, and by patients and service users, [we are] getting out there and playing a very effective part in that system of assurance.”

A regulatory insider said the move signified a “massive ramping up of inspections” and was an attempt to pre-empt likely recommendations from the Mid Staffs inquiry. The insider questioned how thorough the inspections would be.

The plan reverses a significant scaling-back of the inspection regime over the past decade.

The Commission for Health Improvement, subsumed by the Healthcare Commission in 2004, carried out rigorous, week-long inspections. The Healthcare Commission’s visits were more targeted but still formed a large part of its yearly assessment of NHS organisations, called the annual health check.

The CQC took over in 2009 with a much smaller budget and a remit to carry out “risk based” regulation. Between July 2010 and June 2011, 174 NHS trusts - only 70 per cent of the total - were inspected.

The lack of resources to carry out inspections was cited by former CQC chair Baroness Young as a reason for her sudden departure in December 2009, days after major failings at Basildon and Thurrock University Hospitals Foundation Trust were published.

Ms Bower will set out the changes in a consultation this autumn and hopes to fund the new regime out of the £15m that the CQC has requested from the Department of Health. This would help to boost the 800-strong inspection team by 15 per cent.

At the same time, the CQC has promised to make internal efficiencies to release resources for more clinician inspectors.

Nottingham University Hospitals Trust chief executive Peter Homa welcomed the development. He said: “Inspections provide additional assurance to patients, the public and commissioners and staff that services are in the shape they should be.”

Wrightington, Wigan and Leigh Foundation Trust chief executive Andrew Foster said: “I think the NHS is already regulated enough and inspected to death.” But he added: “On the other hand, the CQC is one of the principle regulators and if it only did its work as a paper exercise it could very easily be criticised for not being thorough enough.”