Care Quality Commission Meet the Chief Inspectors, 23 Jul 2013

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From YouTube: An interview with Prof Sir Mike Richards

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Our Regional Director for London, Matthew Trainer, interviews the first Chief Inspector of Hospitals Prof Sir Mike Richards about his background and his plans for the role.

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Good afternoon, sir mike, could you tell us a bit about yourself? good afternoon,? Yes, certainly.

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I'm first and foremost a doctor.. I come from a medical family.

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My father was a gp,, my older sister's, a community pediatrician, just retired,.

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My younger brother is also a gp, but is now leading a.

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Clinical commissioning group so.

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Perhaps surprisingly, it took me until I had been at university a year.

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Even to work out that I might want to be a doctor, but.

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I've had a very happy career as a doctor.

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25 years working in general medicine and then in cancer medicine and then palliative.

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Medicine and then, in 1999,.

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I moved to the department of health as the first national cancer director.

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I was really responsible for trying to bring about a drive and change.

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In cancer services, because we knew we were lagging behind in this country.

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What attracted you to the job of chief inspector of hospitals?.

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I suppose the thing that attracted me, the most.

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Was the challenge. I.

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Believed that I could use some of the experience I've had in cancer, in.

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Bringing a sort of whole system change, but do that on an even wider platform.

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That of hospitals,, which matter enormously to the public.

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The nhs,, as we all know, matters, hugely to the public.

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Hospitals are perhaps the most obviously facing part.

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Of the health service and we need to make sure.

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That our hospitals on delivering high-quality care and to do that.

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We need to measure that, to inspect it, to come up with ratings.

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But that will then work with partners to drive improvement.

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In this new system, you're talking about,, what is the role of the chief inspector?.

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The chief inspector's role is.

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To oversee, to coordinate, to lead this movement.

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For good inspection and.

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To say, we need to learn from others about inspection,.

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To learn, what's been done in this country in different ways,.

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Learn from what cqc has done in the past, learn from the keogh review,.

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Learn from what people do in other countries and bring all that.

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Together and say 'how can we pool that to say this will represent good inspection?'.. I'm absolutely convinced.

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That we need to have large panels.

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Doing this, bringing together doctors, nurses, managers.

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Alongside professional regulator, staff,.

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The cqc staff,, who can really make sure.

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That we do it robustly, that we produce the evidence.

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What I'm hoping to do is to say,. Let's take the.

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Emergency pathway, from the time a person comes to a&e.

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Moves through a&e to.

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The emergency assessment unit or the emergency medical unit or whatever it may be called.

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Then, on to a general ward, then maybe on to a ward for the frail elderly,.

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Follow the patient through that pathway and see is the care.

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Delivered at each step in that pathway really working, because I think often it can.

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Be the handovers between different parts of a pathway that.

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Fail so, for example,.

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How well does a hospital look after patients that are deteriorating.

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And how well do they do that out of hours and at the weekend.

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And do they have the systems in place.

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For early warnings, for escalation, who's there,, do they have the right critical.

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Care outreach service,, whatever it might be.. I think we can then look across a pathway.

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And, of course, actually, within that,, the essential standards will still remain.

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Important., we still need to check that people are getting food and water.

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And so all of those things will remain important, but we'll be doing it in a.

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Different way and with more clinical involvement alongside professional inspectors.

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You've identified a list of 18 trusts as the first be inspected in this new way.

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Why those 18? well,, we thought long and hard about this,.

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About where we should go first., one of the key things I want to do.

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Is to test out our new surveillance tool, as people will know.

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We're out to consultation on this at the moment and we've set out.

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All the the metrics in annex a of the consultation document.

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And I hope people are reading that and will comment on it.

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But we've got a very good start there. So we've got a number of indicators for.

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Each of the five domains of safety, effectiveness,, caring, responsiveness and being well led.

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Those metrics, hopefully, will allow us to.

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To identify trusts that are.

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At higher risk or at lower risk now we need to test that.

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But we think we've got enough there, so we've chosen six trusts that.

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Are apparently high-risk, six that are apparently low risk.

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And 6 that come in the range inbetween and they cover.

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Just about everything, inbetween and.

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This will really help us to know what the range of quality of care.

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Is in this country, and I think that therefore, by christmas, when we complete.

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This wave, we will know much more about our surveillance, tool,, we'll know much more about our.

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Inspection programme and we'll know about the first 18 trusts.. We will definitely be.

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Getting the views of the public., we are committed.

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To having patient and public listening events.

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For each of our comprehensive inspections, whether those are on site at.

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The hospital, whether they are off site in the local town hall, I don't think that matters.

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What we need to do is to give people an opportunity ahead of.

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The programme either tocome to a listening event by advertising it in.

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The local press, or to send us their comments in advance.

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We've got to gather that information together,, that's an incredibly important.

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Part of the preparation phase and if we get the preparation for these.

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Inspections right, we get all the views, so it's views from patients and the public, but it's also the views from healthwatch, from nhs england, from ccgs.

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From health and wellbeing boards, the lot., we want to bring all that in.

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Because that will help us to know when we go in what we are really looking. For.

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How are you going to use our powers and the new role to make sure that services improve?.

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Well, I think, partly it is by taking a comprehensive view of that trust,.

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Giving that trust a clear response where we can show.

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How they are doing about safety,, effectiveness,, caring, etc,.

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And then, by working with our.

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Partner organisations and I've already had conversations with nhs england, with.

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Monitor, with the trust development authority- and I think we're all in this together.

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We will do the inspection bit,, we'll be independent about that.

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But in terms of taking the action, we're all in it, together.

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There's a will to make this work now as never before.

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Will some of that involve a slight shift in our relationship with some of these partner.

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Organisations?.

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If we say a particular trust is not doing.

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Sufficiently well and we report on it as either requiring improvement.

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Or being inadequate,, whether that's for the whole trust or for an aspect of the trust's care,.

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The expectation is that will be picked up.

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And we will also be saying we expect this to be done within.

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X months, whatever that may be., it will then be.

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A mixture, if it is a problem at board level.

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Then monitor or the trust development authority.

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Will need to take action. if it's at a.

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More localised level, it may well be that the trust will take that action.

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The commissioners have a role here as well,.

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Part of our job is that we will be showing to commissioners.

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How good or poor the care is that they are commissioning., they will be.

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Given an independent assessment of the care in their hospitals.

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That's something I think they should welcome.. Now we've read this week yet.

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Again about some serious failings at a series of nhs trusts across the country.

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What's our role in making sure that doesn't happen, again?.

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Our role is to be open,, our role is to say it as it is.

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And my belief is that if we do that.

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And we work with our partners, we will start seeing improvement.

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And I think quite a lot of these improvements can be made quite quickly,.

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They're not all about massive investment, they're, not all about new buildings or.

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Whatever some of these things, we've picked up as problems during the keogh.

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Review that can be, they can get on top of.

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Really quite quickly so that'll be the test. Are we seeing improvements and, when.

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We go back for our follow-ups,. Are we seeing that the action that we have recommended.

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Or the problems that we've spotted have been dealt with?.

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What are the things you would like people to say about cqc? That would show this role's really had an.

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That we trust them,, we trust them to find out what is good and what is less good.

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And we trust them to work with their partners to make things better.

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Mike,, thanks for your time. thank you.