Visits will curb doctors

By Robin Stride

Tougher Care Quality Commission (CQC) inspections starting from April are expected to weaken doctors’ independence as private hospitals go all out to win a new ratings war.

Beefed-up ‘under the skin’ inspections are due to start in six weeks’ time following nationwide trials and feedback from the sector.

Under the new regime, first outlined in Independent Practitioner Today last October, all providers will be awarded ratings – outstanding, good, requires improvement or inadequate.

But there is nervousness at some private hospitals following a shock CQC overall rating of ‘inadequate’ last month for the much-lauded Hinchingbrooke Health Care NHS Trust, managed by private company Circle.

Stephen Collier (right), immediate-past chief executive of BMI group, warned that the relationship bet­ween independent hospitals and practitioners would now inevitably change due to pressures brought on management by the new regime.

Outlining the ratings system to a conference of private hospital bosses, he said the well-publicised Hinchingbrooke case ‘demonstrates the scale of the challenge we all face’.

Mr Collier feared that although the road ahead would now feel ‘bumpy’, the tougher inspections – which judge if care is safe, effective, caring, well-led and responsive to patients’ needs – were ‘a fantastic opportunity’ to show differentiated quality and private sector strengths.

But he said they were also a chance to identify smug complacency, for poor practice to be named and shamed, and dangerous units to be closed.

Effective clinical governance – and a pro-active focus on safety and quality – needed to be at the core of service delivery. This was not an optional bolt-on for already busy people.

He stressed that new hospital ratings were not averages, but would be given on the basis of a ‘worst two’. This meant two ‘inadequate’ judgements on departments in a sea of ‘goods’ were enough to hit the facility with the lowest possible assessment.

Mr Collier, now chairman of the NHS Partners Network, said what was happening with the CQC was further re-inforcement of a private hospital’s obligation to ensure quality across its entire service.

Erosion of autonomy

He told Independent Practitioner Today: ‘What we are seeing here is yet another erosion of consultants’ autonomy. The consultant is increasingly being viewed by regulators as part of the hospital’s service delivery for which the hospital has the regulatory responsibility.’

The CQC tested its new inspections in an initial wave of eight private hospitals late last year. A second tranche began last month (January) as first results came out.

Fiona Booth, head of the Assoc­iation of Independent Healthcare Organisations, said the testing aimed to ensure the approach was appropriate for the private sector.

She told the Healthcare Confer­ences UK event in London that results of the first inspections were keenly awaited, as they would give everyone a fuller insight into how the proposed inspection regime will translate into ratings, and where modifications to the approach might be needed.

Ms Booth said the months ahead were ‘critical’. The independent sector was keen to ensure that communication between providers and the CQC was ‘swift, open and transparent’ and resulted in a thorough and fair regime.

‘Once these inspections start to take place, our focus shifts to ratings and information. I’m sure every­one across the sector agrees that independent hospitals should, and will be, held to exactly the same standards as NHS ones and that comparable data on them should be published. We want patients to be able to make informed choices about their care.’

She said the CQC’s proposed approach followed the NHS acute trust hospital model but with some modifications to take account of the differences between them, notably alternative governance structures, staffing arrangements, the focus on elective provision and the fact that many independent institutions offered single specialty services rather than a range of more general treatment and diagnosis.

AIHO would continue working hard alongside the Private Healthcare Information Network (PHIN) to publish a range of standardised outcomes data for patients using the private sector.