Hospital watchdog says that outpatient services at too many NHS hospitals are doing poorly under greater strain

 

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Patients are waiting too long for appointments at “overcrowded”, poorly managed outpatient departments at NHS hospitals, the health watchdog has said – singling out the non-urgent services as a weak link at more than two thirds of the first wave of hospitals visited under a revamped inspection regime.

Outpatient services – appointments to see consultants and have tests carried out which do not require a stay at hospital – is the area of hospital care which has the greatest “footfall” of patients, but Sir Mike Richards, the Care Quality Commission’s chief inspector of hospitals, told The Independent that too many were disorganised and not responding to patient’s needs.

However, in a report on their first 18 hospital inspections under a new regulatory regime, the CQC found that critical care services – for patients with more urgent needs – were of high quality and performing well, as were maternity services.

Accident and emergency departments are also under “greater strain” than other hospital services, the watchdog said, and are often experiencing long waiting times, overcrowding and staff shortages. 

Sir Mike said that variation in the care provided by the NHS was not only seen from one hospital to another, but even within single hospitals – with outpatient departments typically underperforming, with the “organisational” aspects of their service coming in for particular criticism.

“People are waiting too long, sometimes clinics get cancelled at short notice, they can be overcrowded, there can be inadequate seating and sometimes [medical] notes aren’t available,” he said. “If [inspectors] identify an area that requires improvement it will become very apparent to the hospital that that is the case and we hope that they will take very prompt action to improve that.”

The CQC’s report also included the first hospital ratings – one of the new inspection measures, modelled on Ofsted ratings for schools. Three NHS trusts volunteered to be the first to be rated. One, the Royal Surry County Hospital NHS Foundation Trust, was rated good, while the Heart of England Foundation Trust and the Dartford and Gravesham Trust were both told they require improvement.

To determine the rating eight different services at each were rated outstanding, good, requiring improvement or inadequate, for five different criteria – safety, effectiveness, caring, responsiveness and leadership.

All NHS trusts will receive a rating by the end of next year. Sir Mike said that hospitals should view a low rating as a signal to make improvements “very quickly” to reassure patients. He said that in some cases, patients might use the ratings to determine their choice of hospital for elective care, adding that pregnant women “may wish to use the ratings as a guide as to where they might want to have a baby”.

The CQC has already called for urgent improvements to services at one of the hospitals it inspected. The A&E unit at Good Hope Hospital in Sutton Coldfield was deemed inadequate under the safety criterion, following inspection in November last year. Sir Mike said inspectors have since returned to the hospital and seen “significant improvements”.

Major reforms to the way the CQC carries out inspections were introduced last year by new leaders who branded the organisation “not fit for purpose”. Inspection teams are now larger and include more clinical professionals, and chief inspectors have been appointed for hospitals, GP surgeries and social care.

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