Hospital inspections ‘only add to patients’ suffering’

Falls and bedsores increase after high-pressure visits, say researchers who call for a rethink on policy

Hospital inspections are bad for patients because they divert staff away from basic care, a study indicates.

A review of NHS trusts found that the incidence of potentially dangerous falls and bedsores tended to be worse following a visit by the Care Quality Commission (CQC).

Since 2013, the watchdog has undertaken longer and more complex assessments of hospitals, with inspectors calling at least once every three years.

They then publish reports grading a hospital either Outstanding, Good, Requires Improvement or Inadequate.

The study by the University of York suggests managers – whose careers often depend on achieving a solid rating – are devoting increasing time and resources to preparing for inspections, with costs ranging between £169,000 and £420,000 per visit.

Researchers analysed rates of falls resulting in harm and rates of pressure ulcers at more than 150 hospitals. Both criteria are considered a good bellwether for the quality of nursing.

While both measures are gradually improving in most trusts, the study found the rate of improvement slowed following an inspection.

Dr Ana Cristina Castro, who led the research, said the inspection regime “creates a significant pressure on staff … and also significant costs, not just of the CQC inspectors but also NHS staff who are diverted from other activities.

“We suggest that a less resource-intensive approach should be considered so that all staff can focus appropriately on longer-term improvements.”

The 2013 changes to the inspection regime followed the publication of the Francis Report, the inquiry into widespread failures of care at Mid Staffordshire NHS Foundation Trust which led to the deaths of hundreds of patients between 2005 and 2009.

The researchers argue that given that several methods of inspection have been implemented over 20 years, each with an increasingly complex and burdensome process, that reducing the administrative burden should be tried.

Trevor Sheldon, Professor of Health Services Research at York Department of Health Sciences, wrote an editorial alongside the research paper.

“Research shows us that questionable effectiveness and high burden of health service inspection is not only true of the NHS, but also of healthcare systems internationally,” he said.

“The research shows that inspection regimes, like CQC, need to rethink their approach.

“The question that remains is, what is the right dose of oversight that will help improve quality of care, without adding to an already overburdened staff workload?

The study on inspections is published in the Journal of Health Services Research and Policy