CQC intelligence monitoring report 21 October 2013

The Care Quality Commission has recently changed the way it inspects and regulates acute hospitals.  To help them determine who and when they inspect, they have developed the intelligent monitoring tool to assess a hospital’s performance in respect of a range of indicators. The tool indicates where there may be a need for further review but is not in itself a judgment about the quality of care provided.

The CQC intelligent monitoring report published last week gives Lancashire Teaching Hospitals NHS Foundation Trust an overall risk score of 11 out of a maximum possible risk score of 174 based on performance in respect of 87 indicators applicable to us. The report identified three areas of risk, and four areas of elevated risk.

Three of these risks relate to elevated mortality ratios. Reducing patient mortality has been a key strategic aim for us and we continuously monitor rates using the same tools as the CQC. Where mortality rates are elevated we analyse the data and, where applicable review the case notes of patients affected to identify whether there are any quality of care issues.

In respect of the patient groups identified within this report as having higher than expected mortality ratios, we have undertaken case note reviews that have included independent analysis and found no evidence of substandard care that has contributed to the death of any of these patients. The output of two of these investigations has been shared with the CQC who have confirmed that they do not feel that they need to undertake any additional enquiries. We have not been asked by them to respond in respect of weekend mortality ratios but intend to share the findings of the third investigation with them.   We are currently introducing a more robust and rigorous review process that will ensure that every patient death is subjected to a detailed case review to ensure that we identify and address any quality of care issues  promptly and effectively.

In addition to the mortality ratio alerts, the CQC report highlights a risk in respect of hip fracture patients seeing a specialist consultant within 72 hours of admission.  We were previously aware of this issue and in response  recruited an additional Consultant Orthogeriatrician and are confident that this standard will be met in the future.

The CQC has included an elevated risk in respect of whistleblowing, which triggers on receipt of one or more contacts from staff, and the CQC has received two about us.  We recognise that actively encouraging staff to raise concerns about risks to patients responsibly and without delay ensures that the interests of patients are always put first, and we guarantee that we will protect staff who choose to do so.  

The two remaining risks relate to delays in submitting data to the national database for knee replacements, and problems applying new codes during the transition from primary care trusts to clinical commissioning groups. Licensing issues have been resolved and the knee replacement data has now been uploaded, and we are recruiting additional staff to support the inputting of data.

Karen Partington, Chief Executive of Lancashire Teaching Hospitals NHS Foundation Trust said, “We welcome the Care Quality Commission’s new model of scrutiny because we believe that the NHS should be open and honest, and held to account by regulators and the people who use our services.

“Some of the risks highlighted by the intelligent monitoring report have already been subject to review and action, with others still ongoing.   Where lessons and a need for improvement are identified we have and will continue to take action to make sure the quality of care we provide is of the highest standard.

“Whilst it is of course disappointing to have been placed in the lower 25% of hospitals, I would like to assure patients and our local communities that providing services that are safe, effective and reliable is our top priority, and we will continue to scrutinise and challenge our performance, listen to feedback, and drive continuous improvement to make sure we are delivering care we can all be proud of.”