Watchdog warns NHS on safety for patients stuck on waiting lists

The Care Quality Commission’s new strategy pledges an ‘unremitting focus on safety’, reports Shaun Lintern

The CQC has said it will make it easier for patients to raise concerns about their care (PA)

Hospitals must prove patients are not being put at risk by lengthy delays to treatment as Covid-fuelled waiting lists now top 5 million, the care regulator has warned.

In an interview with The Independent, Ian Trenholm, chief executive of the Care Quality Commission, said while he appreciated the unprecedented pressure on NHS trusts due to the pandemic, they would not be “let off the hook” on safety.

He said hospitals would need to show they were managing waiting lists carefully, with concerns that some patients could deteriorate while waiting for surgery.

In March, the backlog for routine NHS treatment reached a record 5 million in England, the largest number waiting since 2007, with 436,000 patients waiting more than a year.

Mr Trenholm, who started his career as an inspector with the Royal Hong Kong Police Service, said the CQC was sympathetic to the pressures on the NHS and acknowledged there was a need for staff at all levels to have recovery time.

But he added: “Our approach is to make sure that those backlogs, where they exist, are managed safely and that we would expect standards to be maintained. We’re not going to let people off the hook in terms of safety, and we will be asking questions around how backlogs are being managed.

“We’re trying to balance the needs of providers, which are very real, and we absolutely recognise that, with the needs of the public to make sure the public stay safe in all of this.”

The CQC has launched a new strategy for how it will police hospitals, care homes and GP surgeries after the pandemic, promising an “unremitting focus on safety” – an area in which the NHS has consistently performed poorly since the CQC began its new style of inspections in April 2015.

Outlining the future approach, Mr Trenholm said he wanted to make it much easier for the public and staff to raise concerns directly with the regulator.

He said there had been a 43 per cent rise in people logging feedback about care providers in the past year, adding: “What we want to do is try and work out how we can systematically give feedback to individuals about action taken as a result.”

The CQC is investing millions in upgrading a 15-year-old IT system. The new system will allow it to respond to concerns and also make much greater use of real-time data and analysis as it moves away from large formal inspections to more targeted approaches.

The CQC will have an “always on” view of quality, Mr Trenholm said – meaning more frequent, unannounced smaller inspections over larger ones that take more time, plus real-time updates on hospital performance and ratings.

Under planned legislation to reform the NHS, the CQC will be given powers to regulate health systems and be able to say how well local organisations work together.

He said: “How people experience care is as much about the interplay between providers, and how they transit across the system, as it is about the performance of an individual provider in isolation.”

This was part of the CQC becoming a “smarter regulator” he said, adding he believed that as well as spotting a failing hospital, the new strategy would aim to drive actions at a system level to “do something about it”.

“We can use those powers to ask questions. Is this about a hospital? Or is this about a system and are there national issues around particular specialties which need to be addressed?”

The CQC strategy says the regulator will aim to be an advocate for change and speak out on themes and issues that affect patients.

Mr Trenholm said: “We have this privilege of perspective, which is we can see the whole national picture, we can see health and social care, we can see and hear the voices of people that use the services.

“If we get all that right, we can be better at dealing with safety, because safety has always been an area of regulation that has always performed the poorest. That’s always been a worry for us.

“Those organisations who do well from a safety point of view are those organisations that are relentless about learning.”

The new strategy will explicitly target how well hospitals and other organisations promote a safety culture and how honest and open they are after mistakes.

Mr Trenholm said the regulator was particularly concerned about “closed environments” like mental health hospitals and learning disability units where examples of poor care have been repeatedly raised in the past two years.

Ultimately the CQC has the power to prosecute hospitals and providers for failures in care and in the last year the CQC has brought a number of landmark prosecutions against hospitals for failing to provide safe care to patients or for not being honest with families after mistakes.

Mr Trenholm said the regulator was not actively pursuing a prosecution agenda saying: “In extremis, we will of course take prosecutary action, but that isn’t our starting place.

He said: “There are no targets for prosecution, we don’t see prosecution in those terms. I think prosecution, for me, is a vehicle for learning.”

He said the recent cases against East Kent Hospitals University Trust and University Hospitals Plymouth Trust “would have reverberated around boardrooms. That is using prosecution as a mechanism for learning.”