Press release: Survey of NHS organisations sets out challenges for new health watchdog

11 Jun 2003

A survey of NHS organisations has highlighted the challenges facing the new Commission for Health Audit and Inspection (CHAI) in developing an inspection regime that accurately measures trusts against agreed standards, as well as promoting improvement across the service.
The survey, published today, comes as the legislation to establish the strengthened health watchdog is discussed by a cross-party committee of MPs. 
Over a third of the 131 organisations undergoing a Commission for Health Improvement clinical governance review last year responded to the survey. Respondents backed the reviews' focus on developing better systems to ensure quality care, with 44% reporting a positive overall experience of the review process and half reporting that the review had accelerated improvement within their trust.
But the survey also reveals criticisms of clinical governance assessments which will need to be taken on board by the new CHAI. Four clear themes emerged from the responses:

• Objectivity and robustness - many responses raised concerns that the review process is too open to personal interpretation and error, with insufficiently senior review teams and a lack of transparency in the scoring criteria. This raised particular concerns given the impact of the review on a trust's star rating.
• Consistency - on occasions the scoring system, verbal feedback and final report were felt to be at odds with each other. Some respondents felt there was little consistency between reviews carried out on similar organisations.
• Tone and Style - organisations felt that the process of review was not always developmental or supportive and often felt it was more like an inspection than a review. Final reports were often felt to accentuate the negative, rather than take account of other positive findings.
• Data collection - trusts voiced concerns about complex and time consuming requests for data that were not always read or analysed effectively by the review team.
• Flexibility of approach- a proportion of respondents felt that their review did not take account of individual organisations circumstances, such as organisational restructuring.
  

Dr Gill Morgan, Chief Executive of the NHS Confederation said: "External review is never going to be an easy process for organisations put in the spotlight, and nor should it be.  But our survey reveals that there is more that could be done to ensure that the time invested by trusts pays real dividends in helping NHS staff to deliver high quality care to patients.
"NHS organisations want reviews and inspections that help them develop and improve. A key challenge for the new CHAI will be to ensure that the review process is open and constructive, and that the results are robust, particularly given their link to star ratings.
 "The creation of new CHAI is an opportunity for a wider debate about the future inspection of the NHS. We look forward to working jointly with CHI and other partners to discuss how we can establish a new inspection regime that meets our shared goals: improving NHS organisations, public assurance on standards, and better patient care."

Notes for editors

1. The NHS Confederation represents the organisations that make up the NHS. Our members include the majority of NHS trusts, primary care trusts and health authorities in England; trusts and local health boards in Wales; trusts and NHS boards in Scotland; and health and social services trusts and boards in Northern Ireland.
2. In 2002, the NHS Confederation published "Reviewing the Reviewers" which focused on experiences of NHS Trusts where clinical governance reviews had been carried out by CHI in 2001. The report identified areas of concern and made recommendations for improvement. The study has now been repeated for organisations who have been reviewed by CHI and whose reports were published during 2002. Copies of "Re-reviewing the Reviewers" are available from the Press Office.

Contact details

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