Recommendation 51

A specialist cadre of hospital inspectors

The Care Quality Commission should develop a specialist cadre of inspectors by through training in the principles of hospital care. Inspections of NHS hospital care providers should be led by such inspectors who should have the support of a team, including service level user representatives, clinicians and any other specialism necessary because of particular concerns. Consideration should be given to applying the same principle to the independent sector, as well as to the NHS.

The Chief Inspector of Hospitals has begun inspecting in this way.  Useful lessons were learnt from the Care Quality Commission’s targeted inspections of 150 learning disability in-patient units following events at Winterbourne View hospital; these benefitted enormously from the involvement in inspection of trained and supported learning disabled self-advocates and family carers.

Also, building on the approach developed by Professor Sir Bruce Keogh’s reviews of mortality in 14 NHS trusts, the Chief Inspector of Hospitals has started inspections involving teams made up of senior and junior doctors, nurses and allied health professionals; senior managers; and people with experience of using hospital services. Six thousand individuals put themselves forward to be part of these inspections, and the number continues to increase. This is encouraging progress towards ensuring that inspection teams with a range of specialist and lay perspectives will be sustainable.

Through its Chief Inspector of Hospitals, the Care Quality Commission will extend this approach to mental health, community healthcare and ambulance services during 2014/2015, with appropriate adaptation and tailoring to those sectors. The approach will be adapted to independent as well as NHS providers.

New Chief Inspectors of General Practice and of Adult Social Care took up post in October 2013, and will similarly spearhead the extension and development of new approaches to monitoring and inspecting standards of care in those sectors.


In January 2014, the Care Quality Commission started its new inspection programme for mental health trusts, community trusts and general practice out of hours services. In April 2014, the first new style inspections started in adult social care. The Care Quality Commission’s rating of providers in Independent Mental Health (community and hospitals), NHS Specialist Acute Hospitals and NHS Ambulance Trusts is expected to start in early 2015.