From The Times
March 11, 2010

Doctors call for return of hospital checks to end poor care scandals

David Rose, Health Correspondent

A system of regular inspections and monitoring of hospitals, carried out by the royal medical colleges, should be reinstated to prevent scandals of poor NHS care, leading doctors say today.

Hospitals, clinics or GP surgeries should also be accredited under the same process as individual medical practitioners to reassure patients of the quality of a service, the Royal College of Physicians (RCP) suggests.

The proposals, set out in a new policy document, come amid criticism that more than half of hospital trusts inspected last year provided incorrect information on their performance and quality of care.

Professor Ian Gilmore, the president of the college, told The Times that routine training visits by senior doctors to oversee the quality of medical training had ended in 2002.

But he added that scandals such as at Mid Staffordshire NHS Foundation Trust — where an inquiry found that “appalling” conditions had caused the deaths of 400 patients — could have been avoided had such a system been in place.

The Care Quality Commission (CQC) is due to introduce a new system of registration for health trusts from next month, while doctors will have to renew their licences every five years from 2011. But the RCP says that these reforms do not go far enough, and proposes that accrediting individual clinics or surgeries would be “more relevant to patients and the public, the regulator and the profession”.

Setting out its policy proposals for the next ten years in a report tomorrow, the college, which has been responsible for setting medical standards since 1518, adds: “The quality of the service and the performance of the individual practitioners ... are symbiotically linked.

“Measuring the quality of one without the other is likely to give an incomplete picture of the standards of care that a patient and their carers are likely to receive.”

While visits by senior doctors are still carried out in some areas, the system has been “patchy” since medical colleges lost their statutory role for overseeing education, Professor Gilmore said.

He added that he did not necessarily advocate a new system of formal inspections and visits, but said that “softer form of intelligence” could be very valuable in picking up where managers had lost touch with doctors or standards were slipping.

“As an experienced doctor, you can walk on to a ward and know in a few minutes whether or not they provide a good quality service,” he said. “[But] when Mid Staffordshire ‘blew up’, the Secretary of State said that he was surprised the colleges didn’t already know what was going on. We did have better intelligence before, when we were conducting visiting educational rounds.”

The Leading for Quality report says that while there have been real gains in the quality of healthcare, it also criticises the “dispiriting tariffs and process target-chasing so characteristic of the NHS in recent years.”

“We are wanting to reintroduce some form of better networking, and monitoring of hospitals,” Professor Gilmore said. “We think there are ways in, through regional health authorities and college tutors, to work with the CQC and identify earlier where there are concerns, particularly where concerns from staff are not being listened to by managers.”

The General Medical Council, which regulates individual doctors, said that: “Of course the systems that doctors work in must be robust, but all regulation and inspection regimes need to be effective and proportionate to the risks.”