Hospitals to be given Ofsted-style ratings

'Tough and rigorous' ratings aim to drive up standards and give patients and families better insight into quality of treatment

Hospitals will be told to make urgent improvements if any department is providing poor care, under new Ofsted-style ratings prompted by the Mid Staffordshire NHS scandal.

The "tough and rigorous" ratings will go further than Ofsted's single overall ranking for schools in England by giving an official assessment, from "inadequate to "outstanding", based on inspections of every department of every hospital.

The Care Quality Commission (CQC), which regulates NHS care, hopes the ratings will drive up standards and give patients and families a better insight into the quality of treatment they can expect from particular hospital services.

Under CQC plans being unveiled on Monday, inspectors will rate every department, as well as each hospital and hospital trust, as inadequate, requires improvement, good or outstanding. The changes will begin in October, with the first ratings published in December.

The switch from the CQC's widely discredited hospital monitoring system was ordered by the health secretary, Jeremy Hunt, in the wake of Robert Francis QC's report in February into events at Stafford hospital, where between 400 and 1,200 patients died unnecessarily as a result of poor care and neglect from 2005-2008.

Inspectors will examine if the care is safe, effective, caring and compassionate, well-led and responsive to patients' needs, and decide on a rating for each. They will examine if staff have breached any of 10 new "fundamental standards" of care, as suggested by Francis.

Failings such as dementia patients being isolated in their rooms all day and not receiving support and stimulation, would be classed as a breach of the fundamental standards. Lapses such as a patient going thirsty because his or her water jug has not been filled, or hungry because staff have not helped with eating, would not necessarily on their own count as a breach, unless they were found to happen regularly or across a number of departments.

"It's going to be tougher and much more rigorous, and will be much more clear about when services are failing or inadequate," said David Behan, the watchdog's chief executive. Revelations about abusive treatment of patients at the Winterbourne View hospital for people with learning disabilities had also influenced the ratings, he said.

If an inspection reveals problems, the newly appointed chief inspector of hospitals, Professor Sir Mike Richards, will issue a warning notice, giving the hospital a fixed period in which to improve things, possibly just a few days.

Hunt welcomed the plans, as did the Academy of Medical Royal Colleges, which represents the UK's 220,000 doctors. Major changes needed in the NHS included "setting clear standards of care and publishing ratings so that patients have a single version of the truth about how their hospitals are performing on finance, leadership and, most importantly, the quality of care", said Hunt.

But NHS bosses voiced discontent. Mike Farrar, chief executive of the NHS Confederation, said: "We welcome steps to improve transparency within the NHS, but in doing so, we must avoid creating perverse incentives whereby a single focus develops on those areas being measured alone, at the expense of other areas [of care] that are equally as important."

The CQC had not yet persuaded NHS managers to accept the ratings, which risked "skewing resources to only those areas being measured", added Farrar. In a recent poll, 73% of NHS chief executives and chairs disagreed with Ofsted-style ratings.


Denis Campbell, health correspondent

The GuardianTramp

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