Care Quality Commission reports on ‘Hard Truths’ progress

We've made radical changes to the way we inspect hospitals since Sir Robert Francis’ defining report on the poor care at Mid Staffordshire. The changes have been designed to put patients at the heart of our activities and to ensure the public receives robust, transparent and independent information on the quality of care provided by hospitals.

At the time of the publication of Hard Truths in January 2014, many of these improvements were in place. We'd appointed a Chief Inspector of Hospitals and were beginning our new programme of hospital inspections using expert teams.

One year on from Hard Truths, we're pleased to report further progress in delivering improvements in response to Sir Robert Francis’ recommendations. The new-style hospital inspections have been followed by similarly robust inspections of specialist mental health services, community health services, adult social care and GPs and out-of-hours services and we have developed the way we use data to help our inspectors.

We now rate hospitals, care services and general practice, so that the public has clearer information than ever before about the quality of their services, which can help them make informed choices about their care.

CQC Chief Executive David Behan said:

“The changes we have made following Sir Robert Francis’ report have focused on what matters to patients and their families.

“When we inspect, we consider how well people are being cared for and what they think of that care. The voices of people who use services and of the staff who work in them help us decide where and when to inspect and what to look at when we do inspect. We are independent and our reports and ratings provide a clear picture of the quality of care in hospitals. We have found outstanding and good care through our inspections. Where we have found hospital care to be inadequate, we have recommended special measures, which are intended to drive improvement.

“We have come a long way in a relatively short time and more changes will come into effect in April this year. However, there is more to do and we are working hard to embed the changes we have made and extend them to more of the services we regulate.”

Actions in response to the recommendations over that last year include:

• Publishing guidance for providers of care services on its new way of inspecting by means of handbooks for hospitals, specialist mental health services, community health services, adult social care and GPs and out-of-hours services
• Publishing guidance for providers on the Fit and Proper Person Requirement for Directors and Duty of Candour for NHS bodies, and meeting the fundamental standards and our enforcement powers for all providers and launched the Care Act.
• Using inspections in all sectors to gather information about how well providers handle complaints and staff concerns/whistleblowing. For example, we published a review on how well health and adult social care services handle complaints and submitted evidence to Sir Robert Francis’s Speak Up Review.
• Continuing to work with NICE, the Academy of Medical Royal Colleges, the Royal Colleges and their faculties and other bodies to develop regulation, methods for joint working and guidance for providers.  For example, we published an agreement about how we will work with the GMC to drive improvements in patient care
• Putting in place a programme to ensure that the organisation is structured, skilled and supported to deliver this.
• Developing a system of Intelligent Monitoring to help decide when, where and what to inspect.
• Giving greater prominence to safety alerts in its revised surveillance model. Our NHS acute Intelligent Monitoring system includes a composite indicator around completion of safety alerts which contributes to provider’s risk score.

Other commitments yet to be fully delivered include completing the first round of our new inspections, including expanding our new approach to the inspection of other regulated services; rolling out effective enforcement using our new powers; making the most of information from public, staff and other organisations, and building our organisation.