Researchers at the University of York have shown that more-intensive Care Quality Commission external NHS hospital inspections are not associated with improvements in quality of care.
The results have prompted researchers to call for less resource-intensive inspections, allowing trusts to continue with their own internal assessments and focus on making impactful improvements in a realistic timeframe.
Prior to the introduction of the modified CQC inspection regimen introduced in 2013, an inspection involved two to five inspectors, visiting a trust over two to three days, and focused on 28 essential standards. The modified regimen set outs legally enforceable fundamental standards of care, has over 150 indicators, and uses more inspectors for longer.
This interrupted time-series analysis including all acute NHS trusts in England (n=155) used two control groups (new versus historical inspection regime and trusts not inspected). Multilevel random-coefficient modelling of (1) rates of falls with harm and (2) pressure ulcers, from April 2012 to June 2016, was undertaken.
The research revealed that in one year, CQC inspected 66 acute trusts (42% of all English trusts) using the new regime and 46 (30%) using the previous one.
Prior to inspections being announced, rates of falls with harm and pressure ulcers were improving in both intervention and control hospitals. The announcement of an inspection did not affect either indicator. After inspections, rates of falls with harm improved more slowly, and pressure ulcer rates no longer improved for trusts inspected using both regimes.
Presenting the findings in the Journal of Health Services Research and Policy, the authors conclude that neither form of external inspection was associated with positive, clinically significant effects on adverse event rates. Any improvement happening before the announced CQC inspections slowed after the inspection, it said.