How CQC will inspect staffing in its new
approach to hospital inspections
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Our purpose and role
Our purpose
We make sure health and social care services
provide people with safe, effective,
compassionate, high-quality care and we
encourage care services to improve
Our role
We monitor, inspect and regulate services to
make sure they meet fundamental standards
of quality and safety and we publish what we
find, including performance ratings to help
people choose care
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The Chief Inspector of Hospitals’ task
• To inspect all acute NHS hospital Trusts/FTs by December 2015
• To assess whether a Trust is Safe, Effective, Caring, Responsive to
patients’ needs and Well-Led
• To provide a rating on each Trust:
Outstanding
Good
Requires improvement
Inadequate
• To re-inspect when necessary and to undertake focused reviews in
response to specific concerns
• Programme is now extended and includes mental health and community
service and in Q2 2014 independent sector and ambulance trusts
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The new CQC hospital inspection
programme - staffing
We will consider
• The steps taken to ensure there are sufficient numbers of suitably
qualified, skilled and experienced persons who:
• Receive support, training, professional development, supervision and
appraisal
• Are enabled to obtain further qualifications appropriate to the work they
do
• Are enabled to provide evidence of meeting professional standards to
professional regulators
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CQC’s approach
• 3 phases:
1. Preparation
2. Site visits
3. Report
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Phase 1: Preparation
• Development of a data pack combining
• Intelligent Monitoring
(Safety, Effectiveness, Caring, Responsiveness, Well-Led)
• Local data from the Trust
• Data from other sources
(e.g. CCG, NHS England, HEE, Health watch, Royal Colleges,
Professional regulators)
• Development of Key Lines of Enquiry (KLOEs)
• Recruitment of inspection team members
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Phase 2: Site visits
• Announced and unannounced components
• Announced
• Interviews: CEO, MD, DoN, COO, Chair + NEDs
• Focus Groups: Doctors (senior/junior), nurses/midwives
(registered/student/ HCA), AHPs, Governors, admin + others
• Patient and public listening event
• Direct observation (e.g. wards, A+E, OPD)
• Unannounced visit – will pick up on issues identified at the announced
visit and review care out of hours
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KLOE, what good looks like staffing
Safety
• Staffing establishments (levels and skill mix) are set and reviewed at
ward and board level using nationally recognised tools and guidance and
reflect current professional expert body guidance in all areas i.e. National
Quality Board Guidance (NQB)
• The right staffing levels and skill mix across all clinical and non-clinical
functions is sustained at all times of the day and week to support safe,
effective and compassionate care and levels of staff well-being. Staffing
levels and skills are responsive to changing needs and circumstances
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KLOE, what good looks like staffing
Safety
• Staff know how to activate escalation processes which work well, for
example drafting in additional staff to cover increasing levels of demand
or respond to warning signs of rapid deterioration of patients.
• There is an effective infra structure and programme of support to enable
all staff to develop their understanding of practical skills in patient safety
and service improvement.
• All staff know what to do in an emergency situation and these are
practised regularly
• Every patient has a named member of staff who is responsible and
accountable for that patient’s care
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KLOE, what good looks like staffing
Effective
• The organisation makes sure that all permanent and temporary
staff are appropriately qualified and competent at the right level to
carry out their role safely and effectively in line with best practice
• The organisation has a process in place to identify the learning
needs of staff. There re opportunities for professional
development beyond mandatory training. The organisation can
demonstrate that training programmes impact on patient
outcomes
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KLOE, what good looks like staffing
Caring & Well led
Caring
• Patients are supported by trained staff to cope emotionally with
their care and treatment during their stay in hospital. This support
is available when patients need it
Well led
• Board assurance and robust actions re safe staffing, visible all
levels
• Mechanisms to support staff and promote their positive well being
• HR practice, induction, training & development, organisational
vision, values and strategy
• Staff all levels demonstrate actively encouraged to identify risk
and make suggestions for improvement
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Summary
• The new approach to inspecting hospitals represents a radical
change
• Quality is genuinely be at the heart of everything we do
• Having sufficient numbers of suitability qualified and experienced
staff is key in providing good quality safe care
• Staff must receive support, training, professional development,
supervision and appraisal and work in a supportive environment
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Conclusion
Sir Professor Mike Richards, Chief Inspector of Hospitals
committed with Jane Cummings, Chief Nursing Officer
to ensure that the new model of inspection considers the National
Quality Board (NQB) guidance to support the inspection process in
reviewing staffing levels within organisations
and “Hard Truths Commitments” DH January 2014 are considered
within the new inspection framework
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