Inspection/Sources

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• Plans to name and shame failing hospitals and subject their management to "special measures" similar to the tough regime imposed on failing schools were announced yesterday by the health secretary, Alan Milburn. In a move that signals the possible closure of poorly run hospitals, he also promised greater freedom for the best health providers to organise their services with minimum interference from ministers and officials. He said his national plan for reforming the NHS would include a new system for scoring hospitals, health authorities and primary care providers and publishing performance tables to give patients clear information about the quality of service and efficiency of care. Guardian 1 July 2000
• All 12 teachers at a primary school have resigned in the wake of an inspection by the Office for Standards in Education . Guardian 22 June 2000
• The inspector who won't be inspected . Letter from the Director of Education of Durham in Guardian 5 July 2000
• Happy day: it's the HMIs. Guardian letters 8 July 2000

• What is the Commission for Health Improvement?

  An "arms length" health services inspection body, set up in April 2000, with the aim of driving up standards of care across the NHS in England, Wales, and (by invitation only) Northern Ireland. Scotland has its own body, the Clinical Standards Board. CHI carries out investigations into "major system failures" (known in journalese as "failing hospitals") and, separately, it plans to inspect every NHS trust, Health authority and primary care group (known as local health groups in Wales) by 2004 as part of its programme of clinical governance reviews. Clinical governance reviews measure, in each inspected body: the quality of patient care; whether clinical staff are up to date in their professional practice; and that safeguards are in place to prevent clinical errors.

  Does CHI see itself as a bit like Ofsted, the education inspectorate?

  No. They are both inspection bodies that aim to raise standards at the organisations they inspect. However, CHI resents its reputation as 'the Ofsted of the NHS' feeling that this gives it an unwarranted reputation as an aggressive, intimidatory 'hit squad' out to punish recalcitrant NHS organisations. It wants to be known as an 'assessor' rather than an 'inspector' and sees its role as developmental and collaborative. It says its methods are "very different" from those of Ofsted.

  Does the NHS believe CHI is a bit like Ofsted?

  Yes, so far. A recent survey by the Health Quality Service and trade magazine Health Service Journal discovered that most trust NHS chief executives and senior quality managers were "fearful of inspection". They worry it will adopt an Ofsted-style "name and shame" approach, that staff will be made public scapegoats, and that CHI investigators will "relish… wielding a big stick." Like school teachers with Ofsted, NHS managers believe CHI inspections will be costly, stressful, and will distract attention from day-to-day work.

  Does it have the power to close failing hospitals or remove the management?

  No. But it "will report serious findings" to the health secretary or the Welsh Assembly (who may take action). According to health secretary Alan Milburn: "(CHI)…is uniquely placed to respond quickly to and investigate thoroughly, with extensive powers to gather information and interview individuals. Using these it will identify the source of problems, and develop fast and effective solutions. It will not take over the provision or management of services."

  Is it independent of government?

  Technically, yes. Its aim is to publish the truth as it sees fit, regardless of how uncomfortable this may be to government, NHS bodies or to the public. There is some cynicism among NHS staff as to how independent it will be. An internal CHI report in October 2000 admitted: "We need to convince the NHS that we are the developmental body we claim to be… The NHS audience is reasonably aware of what we aspire to be, but is cynical that we will be allowed to be."

  Who decides which NHS organisation will be investigated by CHI?

  It will investigate individual health services "when required to do so" by the secretary of state for health. In addition, "anyone within or outside the NHS" can ask it to conduct an investigation, although in these cases it is a matter for CHI to decide whether or not to proceed.

  Who runs CHI?

  It is chaired by Dame Deidre Hine, former chief medical officer for Wales and co-author with ex-chief medical officer for England, Kenneth Calman of the seminal Calman-Hine report into UK cancer services. The chief executive is Peter Homa, a former trust chief executive and head of the NHS waiting list task force. Board members include two prominent Labour Party-supporting doctors, cancer specialist Professor David Kerr and London GP Sam Everington. Guardian 15 November 2000.
• Surgeons, nurses and management were severely criticised after official investigations highlighted the need for hospital authorities to take more heed of whistleblowers. The commission for health improvement, the government's new watchdog on standards, criticised North Lakeland NHS trust, where elderly mentally ill patients were tied to commodes, and Carmar- thenshire NHS trust, where a patient died after having the wrong kidney removed. An independent report commissioned by the NHS executive said the Oxford heart centre was "on its knees and riven by internal conflict". Guardian 16 November 2000.
• Debate: is Nice in need of a radical rethink? Professor Sir Michael Rawlins, chair of government health advisory body Nice, defends his organisation following today's Guardian comment Guardian Society Info exchange Friday November 17, 2000
• The new director of the NHS modernisation agency, David Fillingham, is to adopt a "softly-softly" approach to the agencies' work as opposed to a more aggressive "inspection-type model". Health Service Journal round-up Publication date: April 5 Guardian Society Friday April 6, 2001  
• University Hospitals Coventry and Warwickshire NHS Trust.  Commission for Health Improvement governance review 18 September 2001 and agreed action plan 14 November 2001.
• Alan Milburn has got it wrong. His ambition to modernise the national health service is admirable. The NHS needs more enterprise, less managerial complacency, more openness. But last week's modernisation moves were woefully mistaken.   Guardian  Society Wednesday October 3, 2001
• Urgent review for hospital which failed ex-Beatle's assailant.  NHS inspectors are to carry out an emergency investigation into a hospital criticised by an official inquiry for its "significant failings" in caring for a schizophrenic who nearly killed ex-Beatle George Harrison in 1999.  Patrick Butler Guardian Society Tuesday October 23, 2001
• Tougher powers for NHS inspectors.  Patrick Butler Guardian Society Friday November 9, 2001
• Ofsted-style body to combat NHS failings John Carvel, social affairs editor Guardian Society Friday November 9, 2001
• Comment Naming and shaming is no way to run a health service.  The NHS reform bill will beef up the power of the commission for health improvement to take action against 'failing' NHS services - but will this do anything more than further undermine staff morale and public confidence, asks Geoff Martin.  Guardian Society Thursday November 15, 2001  
• 'CHI is not to blame for worst hospital spin.' The commission for health improvement's communications director hits back at campaigner Geoff Martin's accusations of dramatising critical inspection reports.  Guardian Society Friday November 16, 2001
• Four failing NHS trusts will be taken over by management teams from other health service hospitals in a radical bid to revive their performance, the health secretary, Alan Milburn, announced today.  Guardian Society Monday February 11, 2002
• The government paved the way for the introduction of private management into the NHS today, after it announced that four failing hospital trusts face a management takeover as part of a bid to drive up performance.  Guardian Society Monday February 11, 2002
• Q&A: NHS management hit squads. The health secretary, Alan Milburn, today announced that top health service managers are to be called in to improve performance at four failing NHS trusts. Patrick Butler explains how the scheme will work.  Guardian Society Monday February 11, 2002
• Hit squads to target failing hospitals. Sarah Boseley, health editor Guardian Tuesday February 12, 2002
• Health inspectors warned today of a serious risk to patients' safety at Brighton general hospital, one of 12 given no stars by ministers last year as an indication of management failings.  Guardian Society Tuesday February 26, 2002
• Management hit squad to take over failing hospital.  Patrick Butler Guardian Society Thursday March 14, 2002
• Feuding doctors put kidney patients at risk, say NHS inspectors.  James Meikle, health correspondent Guardian Tuesday March 26, 2002
• Patients' safety is being put at risk by the overcrowded casualty departments and shortage of beds in three Kent hospitals, inspectors said yesterday.  Guardian Wednesday March 27, 2002
• Watchdog with teeth to monitor how the new pot of gold is spent.  Auditors: Inspectorates will scrutinise and report to parliament.  John Carvel, social affairs editor Guardian Thursday April 18, 2002
• Q&A: the national care standards commission.  David Batty Society Monday April 22, 2002
• Government takes big risk with new 'super' inspectorates.  David Brindle Guardian Wednesday April 24, 2002
• The two new super inspectorates for social care and health will create "serious difficulties" for joint working between sectors, the controller of the audit commission has warned.  David Batty Society Monday April 29, 2002
• The government is shaking up the auditing of the health service, but evidence is growing that too much targetry can be bad for you.  David Walker Guardian Monday May 6, 2002
• Hospital 'put safety at risk' James Meikle Health correspondent Guardian Thursday June 6, 2002
• The chairman of the public inquiry into the death of Victoria Climbié yesterday accused the government of withholding evidence that might have linked the child abuse tragedy to mistakes by the social services inspectorate.  John Carvel, social affairs editor The Guardian Wednesday July 10, 2002 
• Errors led to positive Climbié council report.  David Batty Society Thursday July 11, 2002
• Lowest graded hospitals put under warning.  John Carvel, social affairs editor Guardian Thursday July 25, 2002
• Q&A: NHS star ratings.   As the government publishes comprehensive performance statistics for English NHS trusts, David Batty explains the facts behind the figures.   Society Thursday July 25, 2002
• Looking up from bottom of the heap.  Tania Branigan Guardian Thursday July 25, 2002
• Comment: League tables don't tell the full story.  NHS star ratings are too general and really give nothing away at all, writes John Appleby.  Society Thursday July 25, 2002
• DoH admits publishing invalid data.  David Batty Society Thursday July 25, 2002
• Mental health groups attack 'too positive' performance results.  David Batty Society Friday July 26, 2002
• Hospital criticised for putting children at risk.  James Meikle, health correspondent Guardian Thursday August 8, 2002
• Inspectors slate hospital over staff shortages.  John Carvel, social affairs editor Thursday September 5, 2002 The Guardian
• NHS wastes £150m on dental treatment.  Six-monthly checkups for adults 'not necessary'.  John Carvel, social affairs editor Thursday September 19, 2002 The Guardian  (reporting views of the Audit Commission)
• Fresh doubts cast on NHS league.  David Batty Thursday October 24, 2002
• Service split 'will harm' mentally ill .David Batty in Bristol Tuesday November 5, 2002
• Timeline: a short history of the commission for health improvement.  Patrick Butler Wednesday November 27, 2002
• The commission for health improvement has up until now been the Mr Nice Guy of inspectorates, but with more funding and more powers on the way all that could change, writes Peter Davies.  Wednesday November 27, 2002
• Hospitals in the north of England and the Midlands are performing better than those in London and the south, according to the first regional analysis of quality in the NHS by the government's health inspectorate.  John Carvel, social affairs editor Wednesday November 27, 2002 The Guardian
• The government's health inspectorate began an investigation yesterday into allegations of persistent abuse of dementia patients at a south Manchester hospital.  John Carvel, social affairs editor Friday December 6, 2002 The Guardian
• An NHS hospital where walls were stained with blood, toilets overflowed and patients were treated without privacy in mixed sex wards was told yesterday to pay more attention to hygiene. John Carvel, social affairs editor Tuesday January 14, 2003 The Guardian
• Mental health trust 'complacent' over deaths . James Meikle, health correspondent Friday February 14, 2003
• A "command and control" culture at an ambulance trust led to bullying and inaccurately recorded data on response times, according to NHS inspectors. Tuesday March 18, 2003
• Security and child protection measures at Great Ormond Street children's hospital in London have been criticised by government inspectors. James Meikle, health correspondent Tuesday March 18, 2003
• A new super-inspectorate is to oversee NHS complaints to give patients a bigger voice in the health service and ensure their experiences are used to improve practice. Sara Gaines Friday March 28, 2003
• Feuding among consultants in a hospital's maternity unit posed an unacceptable risk to the quality of care for mothers and babies, the government's commission for health improvement (CHI) said yesterday. James Meikle Tuesday April 1, 2003 The Guardian
• Timeline: a short history of the commission for health improvement. Patrick Butler Friday April 11, 2003
• Ministers' understanding of the ambulance service was called into question yesterday when health inspectors discovered serious defects in an ambulance trust which was awarded top marks in the government's performance tables. John Carvel, social affairs editor Thursday April 24, 2003 The Guardian
• A new mirror was held up to the national health service at the end of last week - more independent than the modernisation agency's annual report, as the health secretary played no part in its compilation. It comes from the inspectors of the commission for health improvement (CHI) and is based on 270 inspections and reviews over three years. Leader Monday May 12, 2003 The Guardian
• NHS managers hit back at hospital league tables. Tash Shifrin Wednesday June 11, 2003
• NHS patients' champion puts focus on rights not needs. Sarah Boseley, health editor Wednesday June 25, 2003 The Guardian
• Family doctors in more than a third of primary care trusts (PCTs) are failing to meet the government's target to see patients within 48 hours, according to the new NHS performance ratings. David Batty Wednesday July 16, 2003
• Five of England's 31 ambulance trusts have been "failed" - awarded no stars in this year's performance league tables, while the number of one-star trusts has more than doubled. Tash Shifrin Wednesday July 16, 2003
• The number of top rated mental health trusts has more than trebled, according to the latest NHS performance league table. David Batty Wednesday July 16, 2003
• Four of the 29 NHS hospitals being groomed by ministers for foundation status were forced out of the running last night when the health inspectorate decided they were no longer good enough to qualify for the top three-star grading. John Carvel, social affairs editor Wednesday July 16, 2003 The Guardian
• Mental health campaigners have branded the NHS performance ratings as "astonishingly unrealistic" for failing to reflect the poor standards of care experienced by many patients.  David Batty Wednesday July 16, 2003
• As the commission for health improvement publishes star ratings for England's hospitals, ambulance services, primary care trusts and mental health trusts, politicians and key health service figures give their responses. Wednesday July 16, 2003
• Q&A: NHS star ratings. As the commission for health improvement publishes performance statistics for English NHS trusts, David Batty explains the facts behind the figures. Wednesday July 16, 2003
• The NHS league tables cannot be used like a restaurant guide to help with hospital selection because patients have little choice over where they are treated - so why rank them, asks Peter Davies. Wednesday July 16, 2003
• The government's method of selecting foundation hospitals was condemned as a fraud yesterday after the Liberal Democrats exposed glaring inconsistencies in the official data of the NHS.  John Carvel, social affairs editor Tuesday August 5, 2003 The Guardian
• Swansea hospitals failing to meet the needs of patients. Health watchdog reports locked doors, slow staff and precious little privacy. John Carvel, social affairs editor Tuesday September 2, 2003
• A healthcare watchdog set up by the government to eradicate the NHS "postcode lottery" of care has failed to achieve its aim, according to a centre right think tank.  Thursday September 18, 2003
• The government's health inspectorate said yesterday that it was seriously concerned about care for older people within the NHS, after a third investigation into local services found unacceptable standards. James Meikle Wednesday September 24, 2003 The Guardian
• Health inspectors are to mount a special investigation into fatal mistakes at the maternity unit of New Cross hospital in Wolverhampton after NHS managers raised concern about the circumstances surrounding the deaths of at least four babies. John Carvel, social affairs editor Friday October 24, 2003 The Guardian
• Broadmoor damned by health inspectors. John Carvel, social affairs editor Wednesday November 19, 2003 The Guardian
• With NHS targets increasingly seen as a burden, the government could soon ditch the controversial star ratings system, says Peter Davies. Friday November 28, 2003
• The government yesterday named and shamed hospital trusts where patients were most at risk of catching one of the most feared superbugs as part of a more aggressive campaign to reduce hospital-acquired infections in England. James Meikle, health correspondent Saturday December 6, 2003 The Guardian
• Alan Milburn interfered with NHS performance tables when he was health secretary in 2002, to engineer a higher star rating for the hospital serving Tony Blair's constituency, the magazine Health Service Journal claims. John Carvel, social affairs editor Thursday December 18, 2003 The Guardian
• The Conservative and Liberal Democrat parties have demanded an inquiry into suggestions that a hospital serving the constituencies of the prime minister, Tony Blair, and former health secretary, Alan Milburn, had its star rating enhanced following ministerial pressure. Thursday December 18, 2003
• Figuring the fiddles. Leader Friday December 19, 2003 The Guardian
• Tony Blair was facing calls last night for a full inquiry into how his local constituency hospital won a coveted three-star rating as it emerged that Downing Street was fully aware at the time that Alan Milburn had intervened to secure its status. Jo Revill, health editor Sunday December 21, 2003 The Observer
• One of the north's leading hospitals is facing the prospect of a fast-track inquiry by government watchdogs after a series of medical and financial problems. Martin Wainwright Tuesday January 6, 2004 The Guardian
• John Reid sought to quash allegations yesterday that his predecessor, Alan Milburn, fiddled the 2002 hospital star ratings, by telling MPs he had a certificate of good conduct from Sir Nigel Crisp, the NHS chief executive. John Carvel, social affairs editor Thursday January 8, 2004 The Guardian
• The government's healthcare watchdog has condemned an NHS trust in west Wales after finding that acutely mentally ill patients and other local people were being put at risk due to its "failing" and "threadbare" mental health services. The Commission for Health Improvement (Chi) found that Pembrokeshire and Derwen NHS trust had failed to prevent patients from harming themselves, despite three serious incidents of self-harm since 2001, and was leaving people, who needed to be detained in hospital for their own and others' safety, at risk in the community.  David Batty Tuesday March 16, 2004
• Staff shortages, poor working relationships and a lack of risk management are recurring themes when health services go wrong and put patients in danger, the Commission for Health Improvement (CHI) has said. CHI, which is being replaced by the Healthcare Commission next week, said that inadequate leadership by trust managers, major organisational change and serious financial problems were also common factors which came to the fore during its investigations. Its report, Lessons from CHI Investigations 2000-03, looked at the 11 investigations it has carried out between November 2000 and September last year. Debbie Andalo Thursday March 25, 2004
• Tomorrow sees the launch of the new Commission for Social Care Inspection (CSCI), and the Commission for Healthcare Audit and Inspection (Chai) as well as the first wave of foundation hospitals. But how many disabled board members are there on these and hundreds of other public bodies? Wednesday March 31, 2004 The Guardian
• The government has launched a six-month review of ambulance services to be headed by London brigade chief Peter Bradley. Performance by ambulance service trusts - measured largely on response times to 999 calls - has been patchy and uneven. Ten of England's 31 trusts achieved the maximum three stars in last year's performance ratings, with another seven winning two stars. But nine trusts secured just one star with five zero-rated. Tash Shifrin Monday May 10, 2004
• Top performing hospitals will be granted an inspection "holiday" as part of moves to cut the overload of NHS scrutiny organisations, health minister Lord Warner announced today. More than 30 bodies can inspect aspects of NHS trusts' performance and many more can make visits under current arrangements. A package of measures aims to streamline the process and reduce the burden of bureaucracy. The new measures include joint inspections by regulatory bodies to cut the number of visits hospitals face, more coordinated data collection and fewer, more consistent and better-prioritised recommendations from the inspecting bodies. Tash Shifrin Wednesday June 23, 2004
• Patients cannot give "meaningful consent to treatment" because of the failure of healthcare professionals to involve or inform them properly, a healthcare watchdog warned today. The Healthcare Commission made its summary conclusions after checking the NHS pulse in the second national patient survey. Over 300,000 patients were asked about their experiences in 568 English NHS trusts. Alongside a second round of monitoring the experiences of adult patients in primary care trusts, the Healthcare Commission gauged the views of young hospital patients (under 18 years), and users of mental health and the ambulance services. The commission is particularly concerned by the results which show that healthcare professionals are failing to inform patients properly or to involve them adequately in planning their care - most notably in services for people with mental illness. Helene Mulholland Wednesday August 4, 2004
• The government marked its return from holiday yesterday by unleashing a new tactic, nicknamed "saturation bombing" by Whitehall, on the hospitals, GPs and clinics of a prototype region. Hundreds of patients and health workers suddenly found a minister, one of the 12 "tsars" in charge of main health services, or the chief medical officer, Sir Liam Donaldson, at the end of their bed or looking over their shoulder. The head of the National Health Service, Sir Nigel Crisp, was there too, as a helter-skelter round of almost 50 visits took in every type of health delivery in Leeds, Bradford and Wakefield, as well as surrounding smaller towns and countryside. Martin Wainwright Friday September 3, 2004 The Guardian . 'I'm a matron ... I used to be a clinical services manager.' Martin Wainwright Friday September 3, 2004 The Guardian
• The government is considering plans to merge up to 13 public service inspectorates into just four bodies in a move to cut costs and bureaucracy, it emerged today. According to a report in the Financial Times, the idea involves amalgamating the Commission for Social Care Inspection, which was only launched in April, with NHS watchdog the Healthcare Commission. Under the plan outlined in a Cabinet Office slide presentation aimed at saving £600m, there will also be just one inspection regime for local government taking in the Audit Commission, the Fire Inspectorate and Benefit Fraud Inspectorate. The other two super inspectorates would cover education and criminal justice. Matt Weaver Thursday October 14, 2004
• The first NHS trust in England to be officially reprimanded for persistently failing its patients was named yesterday as Mid Yorkshire Hospitals, a recently merged group of hospitals covering Pontefract, Wakefield and Dewsbury. The Healthcare Commission said Mid Yorkshire was guilty of "systemic management failings over a number of years, from the most senior level down." Deficiencies included the inability to deal with feuds between rival groups of doctors and unacceptable delays of up to three years in diagnosing patients. The trust's debts are expected to reach £40m by March. John Carvel Thursday December 16, 2004 The Guardian
• Millions of NHS patients think doctors do not give them enough information to make sensible choices about how they want to be treated, the health inspectorate for England warned today. The Healthcare Commission's annual survey of patients found 30% did not feel fully involved in decisions about their medical care. The survey of 140,000 patients also confirmed anxiety about lack of cleanliness in hospitals. John Carvel, social affairs editor Monday February 21, 2005 The Guardian
• NHS cancer care better, but many still wait too long. Prostate patients and Londoners the most dissatisfied, says survey. Sarah Boseley, health editor Friday February 25, 2005 The Guardian
• Hospitals in England will face random spot checks from teams of health inspectors under a new system of lighter-touch regulation announced yesterday by the Healthcare Commission. Sir Ian Kennedy, its chairman, said the star rating system of grading NHS trusts will be scrapped next year as part of a drive to reduce red tape. Hospitals and primary care trusts will be required to make a declaration on whether they meet government-set standards of safety, effectiveness and care. John Carvel Thursday March 31, 2005 The Guardian
• Nigel Edwards welcomes the replacement of star rating for NHS trusts with a more responsive, flexible system. Monday April 4, 2005
• Day surgery units at NHS hospitals in England are wasting nearly half their operating time through poor management, the health inspectorate warns today. If the least efficient units adopted the practices of the best, the NHS could perform an extra 74,000 operations a year, the Healthcare Commission says. Its report follows a decision by Patricia Hewitt, the health secretary, to spend £2.5bn over the next five years on a further round of contracts with the private sector to perform fast-track day surgery on NHS patients in independent treatment centres. The commission did not have the authority to examine the first wave of independent centres to establish whether they were more efficient.  John Carvel, social affairs editor Monday July 11, 2005 The Guardian
• Lives of mothers and babies are being put at risk by poor standards of maternity care, the head of the NHS inspectorate said yesterday. Sir Ian Kennedy, the chairman of the Healthcare Commission, highlighted concerns about safety and quality of services in hospital baby units in England and Wales as he prepared to give his annual report to parliament today. All trusts will have to review their standards in maternity units in an attempt to end huge discrepancies in care, following the commission's devastating verdict on their performance. James Meikle, health correspondent Monday July 18, 2005 The Guardian
• Managers braced for the last NHS league tables before the system is scrapped today warned that many hospitals may drop down the table, despite improvements. Hélène Mulholland Tuesday July 26, 2005
• As watchdog the Healthcare Commission publishes NHS league tables, SocietyGuardian.co.uk explains the facts behind the figures. Wednesday July 27, 2005
• The NHS watchdog is failing to provide patients with an accurate picture of hospital hygiene and superbug rates, consumer groups and doctors' leaders said today. The Consumers Association, the Patients Association and the British Medical Association (BMA) branded the Healthcare Commission's latest assessment of hospital cleanliness and MRSA infections as worthless and unambitious. David Batty Wednesday July 27, 2005
• Mental health trusts lag behind in NHS ratings. David Batty Wednesday July 27, 2005
• Star ratings cover up as much as they reveal and don't help patients, writes Frances Blunden. They should be detailed, easy to understand and available to all. Wednesday July 27, 2005
• Health services for children and teenagers, smokers and drug addicts are to be targeted first by the healthcare watchdog under a new ratings system. The Healthcare Commission said its new "improvement reviews" would focus on areas that could have a major impact on boosting people's well-being in England. Monday August 15, 2005
• The landmark closure of a hospital inpatient unit today suggests that the health regulator is getting to grips with the poor quality of services for people with a learning disability. The Harleston adolescent mental health unit, at St Luke's hospital in Norfolk, is to shut after an unannounced inspection by the Healthcare Commission uncovered a number of serious problems. It is the first forced closure of an independent provider by the commission. It follows an investigation by the commission in the summer into alleged abuse at the Cornwall Partnership NHS Trust, which found "significant failings" in the level of care of adults with learning disabilities at Budock hospital, near Falmouth.. The commission today launches a three-year strategy for improving the care of adults with learning disabilities across England. It incorporates a number of initiatives to improve care, including an audit of all inpatient care, an investigation of long-stay hospitals, and the appointment of regional "champions" to monitor services on an ongoing basis. Mary O'Hara Wednesday November 23, 2005 The Guardian
• The health inspectorate plans to publish information about the death rates of individual heart surgeons in April, a year after a Guardian inquiry cast doubt on the reliability of some data collected by hospitals. Sir Ian Kennedy, chairman of the Healthcare Commission, intends to make the results available on an official website in four months. They will allow patients to choose a surgeon on the basis of his or her success rate for similar operations. Sarah Boseley and John Carvel Monday January 2, 2006 The Guardian
• ITCs to face clinical audit over care quality concerns. An independent audit to review the clinical quality of independent treatment centres with NHS contracts is to be launched by the Department of Health, in an attempt to head off criticism from orthopaedic and ophthalmic surgeons about the quality of operations at the centres. The audit will be carried out by the Healthcare Commission in partnership with the medical royal colleges. A DoH spokesperson said: "As well as assessing the delivery of care in the centres, the review will assess views and concerns from the medical royal colleges, clinical specialist associations and other groups who have an interest in the programme." Summary by Keep our NHS Public of  Health Service Journal 27 April 2006
• Doctors to be graded for quality of service. Every doctors' surgery is to be inspected and awarded Michelin-style stars so that patients can tell the quality of care offered by their GP at a glance. The new GP ratings will be reviewed - with the possibility of upgrade or demotion - every three years after a two-day assessment by a panel including a doctor, nurse, surgery manager and patient representative. Britain's 10,500 GPs will be encouraged to display their rating on a plaque outside their surgery and also on letterheads. Practices that repeatedly fail to achieve the basic level can expect to be replaced. The scheme, being drawn up by the Royal College of General Practitioners, should be in place by next April. It will apply to all providers and help patients to choose between the growing number of private health firms looking to move into the family doctor sector. The minimum standard - a Level 1 rating - will require GPs to pass assessments including on opening hours, prompt telephone answering and flexible booking as well as the standard of facilities and quality of care. Levels 2 and 3 will be judged on similar but higher standards, with the top grade requiring extra measures such as research into patient needs and greater responsiveness to community needs. Patricia Hewitt strongly supports the ratings as a way to regulate general practice and inform patients better. Separately, six million patients will be asked to assess their GPs over the next year after complaints about problems in booking appointments. Ministers want to increase the pressure on GPs to perform after salary rises last year. Summary by Keep our NHS Public of  Times 6 June 2006
• Treaty clash between rivals. Friction between regulators Monitor and the Healthcare Commission was growing this week over the former's reluctance to sign up to a concordat designed to reduce the regulatory burden on trusts. Monitor chair Bill Moyes criticised the commission for its persistent attempts to get it to join the concordat which was set up in June 2004. It aims to remove overlap and duplication in inspection, audit and review. Moyes said he was worried that trusts subject to a Monitor intervention would be able to use the concordat to 'fend' it off. Summary by Keep our NHS Public of  Health Service Journal 8 June 2006
• GPs pull out of rating scheme. The Royal College of GPs has pulled out of talks with the Department of Health over plans to grade the performance of family doctors, fearing that ministers were trying to hijack the scheme. Patricia Hewitt had been delighted with the plan, telling journalists that it was tantamount to star rating of GP premises. The college said its members were concerned the scheme could be misused as a star ratings system, and over the implications for GP workloads. Summary by Keep our NHS Public of  Guardian 9 June 2006
• Health ministers have devised a plan for "mystery callers" to try to book appointments at every GP surgery across England to identify whether doctors are fiddling their waiting time records, the Guardian has learned. The crackdown is intended to ensure patients can book to see a preferred GP a few days ahead, as well as taking pot luck on the day.  John Carvel, social affairs editor Wednesday June 21, 2006 The Guardian
• Accounting for the regulators. The direct costs of public service regulators appear in general to amount to less than 0.5 per cent of the costs of the services they regulate - a conclusion reached by dividing their declared budgets against spending on services. To that has to be added the, usually unquantified and potentially much larger, costs on those being regulated - preparing for inspection, being inspected and responding to the results. In 2004/ 05, the Healthcare Commission cost around £76m, 0.1 per cent of the NHS budget. That doubles once the costs of the National Institute of Clinical Excellence, Monitor - the foundation trusts regulator - the Patient Safety Agency and some other regulators are added. Those costs exclude the impact of the Audit Commission, the Health and Safety Executive, and the medical royal colleges; some calculations suggest that more than 100 bodies have the right to demand information from the average NHS trust. Summary by Keep our NHS Public of Financial Times 11 October 2006
• Health watchdog warns of future 'crunch'. The drive to cut the burden of regulation on the public sector is reaching the stage where the watchdogs might be rendered incapable of doing their job, Sir Ian Kennedy, chairman of the Healthcare Commission, the NHS inspectorate, has warned. He said the government was working to telescope 11 public sector regulators - ranging from the Audit Commission and the five agencies that inspect the criminal justice system to those looking at health and children's services - into four between now and 2008. Summary by Keep our NHS Public of Financial Times 11 October 2006
• Doubt cast on 'risk-based' inspections. The biggest test yet of the government's new "risk-based" system of inspection and regulation raised questions about whether it will give the right level of protection to the public. The Healthcare Commission disclosed that half of the organisations that underwent an inspection under the new system had their own estimate of how well they were doing downgraded. In only 15 cases (12 per cent) was their account sufficiently misleading for the inspectorate to amend downwards the final score. The figures were disclosed as the government demands a shift away from routine, often annual, inspections of companies and organisations in an attempt to reduce the burden of regulation across both the public and private sectors. Instead, organisations will frequently be expected to self-declare that they are complying with the law or with government-set standards. Regulators will check that declaration against other available data. Inspections will then follow only on a random sample, so organisations risk being found out if they lie or where other information makes regulators suspicious of what they have been told. The commission undertook 70 "risk-based" inspections - about 15 per cent of the total. Another 57 organisations, or 10 per cent, were inspected randomly. The random inspections suggested 42 per cent of all organisations may have misreported their achievements to some degree - but only about 10 per cent or so badly enough to have affected their overall score. Summary by Keep our NHS Public of Financial Times 12 October 2006
• Joint health and social care regulation body delayed as plans are left out of Queen's Speech. The merger of the health and social care inspectorates looks set to be delayed by at least six months following the absence of a bill to implement it in the Queen's Speech. Staff were being told the merger would not now go ahead until 'late' in the target year of 2008. It had originally been expected to take effect in the spring.  Summary by Keep our NHS Public of Health Service Journal 23 November 2006
• New regulatory body for NHS. Competition in the over £80bn market for the NHS is to be regulated by a new health and social care body, the Department of Health has announced. All NHS hospitals will become "registered" for the first time under a single regime that will cover both the independent and NHS sectors, allowing the regulator to withdraw all or part of an NHS hospital's services. The idea is part of a new regulatory framework that will follow the merger of the Healthcare Commission, the Commission for Social Care Inspection and the Mental Health Act Commission. However the schedule has slipped with the department not expecting the new set up to be operational until 2009-10.  Summary by Keep our NHS Public of Financial Times 28 November 2006
• 'Inspection overload' for the NHS. The NHS confederation has said that the NHS is overburdened by inspections from at least 56 different bodies. The confederation, which represents 90% of managers, says the inspections are important but that the plethora of visits and information requests can be uncoordinated and place unnecessary burden on the NHS. The government has said it is seeking to minimise the impact on the health service, as have individual regulators. However the NHS Confederation says it has actually increased. The 56 bodies identified in the report range from the Healthcare Commission to the NHS Litigation Authority, however there are so many that the confederation could not be precise. Summary by Keep our NHS Public of BBC Online 8 March 2007
• Leak reveals plan for Ofcare regime of fines and closures. Underperforming trusts will face fines and closure under powers given to new health and adult social care regulator Ofcare. The new regulator will replace the Healthcare Commission, the Commission for Social Care Inspection and the Mental Health Act Commission in April 2009. It will be able to charge trusts a registration fee. A draft of the Department of Health's latest plans for regulation of health and social care, following a consultation on its proposals published in November 2006, says the new regulator will be responsible for quality and safety and will be able to impose fines on underperforming trusts. It says Ofcare, short for the Office of Health and Adult Social Care, could also instigate a statutory warning notice demanding improvements, a formal caution, a temporary suspension of registration, conditions restricting what can be provided or criminal prosecution. As set out in the original proposals, failing trusts and services could also be shut down by losing their registration. The current procedure, in which the Healthcare Commission places failing trusts under special measures, will be abandoned. Strategic health authorities and the DoH will retain responsibility for assessing the financial performance of NHS trusts, and Monitor for the financial performance of foundation trusts. Where a provider is shut down, PCTs will be responsible for ensuring continuity of care - but Ofcare will have to 'consider the balance of risk' on how this will affect patients. While commissioners will be subject to performance assessment, the document says there is no need for a commissioner failure regime. This is because reform has changed the regime for providers but not for the management environment. Summary by Keep our NHS Public of Health Service Journal 7 June 2007
• No dignity for older patients on NHS wards, says report. Health inspectors are to mount spot checks on NHS hospitals after finding hundreds of older people being treated without dignity or adequate privacy on wards across England. In a report today on conditions in 23 hospitals, the Healthcare Commission said only five complied with all the government's core standards for dignity in care. Others were found to provide degrading treatment, including making incontinent patients wear nappies and placing older women in mixed-sex bays shielded by skimpy curtains on insecure rails. The commission included Barts and the London NHS trust among eight hospitals that failed the dignity test and were issued with a formal warning. Another 10 trusts were told to make improvements, including seven of the government's flagship foundation hospitals, which were supposed to be among the best in the country. The commission appealed to patients, carers and relatives to blow the whistle whenever they have concerns about the treatment of vulnerable older people. John Carvel, social affairs editor Thursday September 27, 2007 The Guardian
• Quarter of trusts failing on hygiene, survey reveals. More than a quarter of NHS trusts in England failed to comply with the hygiene code brought in by the government last October to combat superbugs in hospitals and doctors' surgeries, the Healthcare Commission discloses today. In a wide-ranging review of 394 NHS organisations, it found 111 trusts where patients were not adequately protected from infections, including the killer bugs MRSA and Clostridium difficile. Most trusts admitted the failings, but inspectors identified 12 where senior managers signed a declaration saying they were complying with national standards on infection control. They were later discovered to have breached the rules. John Carvel, social affairs editor Thursday October 18, 2007 The Guardian.
  • Map: the best and worst performing trusts (pdf)
  • Q&A: NHS league tables 2007. David Batty Thursday October 18, 2007 Guardian Unlimited
  • How good is your local hospital? Guardian blog
  • Independent watchdog says NHS performance is improving. Healthcare Commission
  • Tough action for patients on failures in infection control. Healthcare Commission
  • Healthcare Commission to look into concerns at Royal Cornwall Hospitals NHS Trust. Healthcare Commission
  • Webpage for selected Trust etc. Healthcare Commission
  • Comparative tables. Guardian (pdfs)
    • Acute trust services
    • Acute trust resources
    • Primary care trust services
    • Primary care trust resources
    • Other trust services
    • Other trust resources
• Tough new regulator for health and social care. A tough new regulator for health and adult social care services will ensure good quality and safe care for the public. Care & Health 25 October 2007
• The future regulation of health and adult social care in England. This document is the Government's formal response to the November 2006 consultation document The future regulation of health and adult social care in England, the consultation ran from November 2006 to February 2007 and over 100 written responses from a wide variety of stakeholders were received. Download response to consultation. View all Respondents: click here.  Care & Health 25 October 2007
• Row threatens to undermine hospital superbug fight. A row between the Department of Health and the NHS standards watchdog is threatening to undermine the government's drive to combat hospital superbugs, the Guardian has learned. The dispute flared last week after the department told a journalist that Alan Johnson, the health secretary, was angry with the Healthcare Commission, the body that inspects standards of hygiene and infection control in hospitals across England. The commission had found management failings at Maidstone and Tunbridge Wells NHS trust in Kent that contributed to the deaths of 90 patients during two outbreaks of the superbug Clostridium difficile. According to an article in the Times on Wednesday, Mr Johnson accused the commission of failing to alert ministers or protect patients once it discovered the scale of the infection. A commission spokesman said Sir Ian Kennedy, the chairman, was "shocked and outraged at what he saw as an affront to the good work that was carried out by the commission's team". He added: "Sir Ian felt a line had been crossed with the suggestion that the commission would stand by while people died." The commission made strong representations to the Department of Health and Mr Johnson wrote to Sir Ian clarifying his position. The health secretary did not explain how the Times came to be briefed or accuse the paper of misreporting. But he told Sir Ian: "The sentiments attributed to me in the press on your recent report do not reflect my views ... I am clear that the commission's judgment in this investigation was that the situation in the trust had improved to the point where intervention powers were not needed." The letter stopped a public row between Sir Ian and Mr Johnson last week, but the department's decision to brief against the commission has undermined the relationship of trust between the organisations that is needed to maintain effective action against hospital infection. The commission issued a detailed rebuttal of the allegations. It said it kept the department informed about the progress of its investigation in Maidstone. "Had we thought lives were at risk we would have taken action," it added. The row came to a head on Wednesday when Mr Johnson published plans to merge the Healthcare Commission with other regulators, which inspect social care and mental health. The merger proposal first surfaced in March 2005 when Gordon Brown, then chancellor, ordered a reform of regulation to cut costs and reduce the burden of inspection on hospitals and other organisations. But Mr Johnson presented the same proposal last week as a device for toughening infection control. John Carvel, social affairs editor The Guardian Tuesday October 30 2007
• Healthcare Commission response to proposals on regulation of health and social care. It was very encouraging to hear the Prime Minister recognise the importance of independent regulation when he expressed a desire for 'a stronger healthcare commission' in his speech to the Labour Party conference a few weeks ago. Care & Health 31 October 2007
• Health merger to cost £140m. The merger of the current health and social care inspectorates with the Mental Health Act Commission is to cost £140m health ministers have admitted. The three-way merger of the Healthcare Commission, the Commission for Social Care Inspection and MHAC will in the long run save £60m a year, the Department of Health claims. But the wind-up costs - for a merger that was originally announced as a cost saving measure - will amount to £140m, Ben Bradshaw, the health minister, has confirmed. Summary by Keep our NHS Public of Financial Times 13 December 2007
• Commission sets out proposals for 2008/09 assessment of NHS trusts.   Watchdog to push trusts to ensure all patients have a guarantee of basic standards of care. Care & Health 20 December 2007
• Health chief attacks £140m NHS 'tinkering'. NHS patients' safety will be compromised by the government's costly and ill-considered plans to tinker with the regulation of healthcare, the head of the health inspectorate told MPs. Sir Ian Kennedy, chairman of the Healthcare Commission, said legislation to merge his organisation with the social care and mental health inspectorates could scupper the prime minister's campaign to make hospitals safer. In an outspoken memorandum, he told the cross-party committee scrutinising the health and social care bill that work to improve standards of care and hygiene would lose momentum if inspectors were distracted by at least two years of unnecessary upheaval. The merger would cost £140m and the rationale was unclear. Merging the inspectorates would not help fight infection and the Healthcare Commission did not need the extra powers it was being offered in the bill. Summary by Keep our NHS Public of Guardian 10 January 2008

See Society Guardian index on NHS quality and performance

Commission for Health Improvement, NHS performance ratings: Acute trusts, Specialist trusts, Ambulance trusts, 2002 / 2003

Commission for Health Improvement, NHS performance ratings: Primary care trusts, Mental health trusts, Learning disability trusts, 2002 / 2003

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Sheila Porter-Williams
Campaign for Health Service Democracy
Green Haven, Halfway Lane
Dunchurch
Rugby, Warwickshire CV22 6RD
sheilaCHSD@porter-williams.freeserve.co.uk