The NHS has taken a battering in the past 12 months. The Mid-Staffordshire inquiry revealed appalling levels of hospital care; reports of thousands of avoidable deaths at some of England’s worst-performing hospitals caused distress, only to later be discredited; constant criticism came from both sides of the House of Commons over everything from A&E waiting times to the quality of hospital food.
Amid the maelstrom, the Health Secretary Jeremy Hunt announced the creation of a new post: chief inspector of hospitals or, as he dubbed it, the nation’s “whistleblower-in-chief”.
The man appointed for the task in July was professor Sir Mike Richards, one of the most respected figures in the health sector, who had previously worked as the Government’s highly successful cancer tsar. The Health Service Journal has ranked Sir Mike behind only the Health Secretary and the incoming chief executive of NHS England, Simon Stevens, among powerful figures in the sector.
He is an expert who is unafraid to cast a cold eye on life (and death) in England’s hospitals and, in his own words, “say it as it is”.
So given the kind of year the NHS has had, what does the health service’s most clear-eyed critic have to say about his first few months in office, having already completed 18 acute hospital inspections under the revamped regime? “Generally we have seen a huge amount of very good care,” Sir Mike says, pausing for a moment as if weighing his words. “Compassion in the NHS is alive and well.” And then with extra emphasis: “We’ve also seen some really excellent care.”
He admits that it hasn’t all been good news. “We have seen variation. There is variation between the best hospitals we’ve seen and the ones that are struggling… What is interesting is that within an individual hospital there is variation. The maternity service might be very good but the A&E service might require improvement.”
Proving Sir Mike’s point on variation of results, the organisation he spearheads, the Care Quality Commission, recently published reports on four of the 18 hospital trusts so far inspected. The results were indeed mixed.
One – Barking, Havering and Redbridge – has been placed in special measures because its A&E wards don’t have enough doctors to always operate safely. Another, the Royal Bournemouth and Christchurch, came in for severe criticism, with patients left in soiled beds on elderly care wards. But the other two attracted warm praise, in particular the Salford Royal, with which Sir Mike declares himself “incredibly impressed”.
The media and the public generally focus on the worst performers, and the shocking, albeit isolated, incidents. But are negative headlines obscuring the bigger picture?
Sir Mike suggests, tentatively, that on the whole, the NHS may actually be doing rather well, with the potential to do even better.
“What I think is important is that we are now looking at a spectrum,” he says. “We have looked at high-risk trusts, but have deliberately in our pilot programme looked across the spectrum. What we can now say is that there are some very good hospitals in this country, and it is possible, within the NHS, to receive good, excellent, even outstanding care.My contention is that if it can be done by the NHS, we’ve got to make sure every hospital is moving in the direction of the best.”
It’s a philosophy that lies behind Sir Mike’s new inspection programme, and the new regime for failing hospitals which has already seen 14 hospital trusts placed into special measures. Those hospitals will receive outside help from senior managers at the best-performing trusts.
His CQC inspection teams also include top people from around the NHS. In the summer he put out a call for “a small army” of inspectors, and 7,000 people responded. His teams, usually of around 30 people, consist of doctors, nurses, hospital managers from other trusts and, crucially, patients.
Sir Mike insists that taking part in inspections – which last for around four days – is “professional development”, and wants trusts around the country to release staff to join his teams.
The ultimate goal is a joined-up NHS, where no hospitals are allowed to become remote outposts of bad practice – as happened in Mid Staffordshire – but instead all share ideas and expertise, to become one another’s most useful critics. “They will see how other trusts are being run, which gives them insights that they can take back their trusts,” Sir Mike says. “ That’s part of the learning that will come out of all this: much better learning, around the country, of what is good practice in quality and safety,” he says.
Affirming his belief in the “ideal” of a free public health service, Sir Mike says: “When I hear student nurses say [they are] prepared to do a round trip of 100 miles to work in this place, that makes me quite emotional, because they are committed, the hospital has to be good, and that’s something we have to celebrate.”
Sir Mike says he does not have “rose-tinted spectacles” and would “say it as is” to expose poor care. Since he took on the post, he has been a harsh critic of several trusts, and also of the state of maternity services in the NHS. He has recommended that two trusts be placed in special measures. But his latest comments will be welcomed by NHS staff who have endured a year of near-constant criticism of the health service, following damning reports into underperforming hospitals and concerns about pressures on A&E wards.
The Francis Report into Mid Staffordshire NHS Foundation Trust, published last February, prompted a major review of 14 NHS trusts with higher than average mortality rates. The subsequent report, by the NHS medical director Sir Bruce Keogh, led to media reports of 14,000 avoidable deaths. These were later discredited, but the report also exposed failings that required 11 trusts to be placed in special measures.
This year, dozens more hospitals will be given the Sir Mike treatment, on the way to completing all 160 planned inspections. Undoubtedly, some will end up on the special measures list, but for the chief inspector the start to 2014 also carries hope that even the weakest hospitals have what it takes to turn things around: dedicated, compassionate staff.
“We are seeing absolutely committed clinicians, both doctors and nurses and allied health professionals, everywhere we’ve gone, even in some of the trusts that are struggling most,” Sir Mike says. “We have seen people who are really committed to delivering high-quality care and are trying extremely hard. They may need extra support, but what we are seeing is a very committed workforce – quite remarkably so.”
“I am full of admiration for them. It is what I hoped I would see,” he adds. “But seeing is believing.”
Sir Mike Richards: A life in brief
Educated at the Dragon School in Oxford and then Radley College, Sir Mike was a hospital physician for more than 20 years. He is also an expert on cancer, having been an Imperial Cancer Research Fund research fellow in medical oncology at St Bartholomew’s Hospital in London (1982–86), and then an oncology consultant at Guy’s Hospital in London (1986–95) and professor of palliative medicine at St Thomas’ Hospital from 1995. He was made a CBE in 2001 and given a knighthood in 2010.