Recommendation 101

Peer review inspections for patient safety


While it may be impracticable for the National Patient Safety Agency or its successor to have its own team of inspectors, it should be possible to organise for mutual peer review inspections or the inclusion in Patient Environment Action Team representatives from outside the organisation. Consideration could also be given to involvement from time to time of a representative of the Care Quality Commission.
Patient Environment Action Team inspections have now been replaced by Patient-led Assessments of the Care Environment. These are annual inspections of all NHS hospitals (and some independent sector ones) that cover provisions for privacy and dignity, cleanliness, food, and general décor/ maintenance of hospital buildings. They are carried out by teams that include at least 50% patients or members of the public, which increases the external scrutiny (the Patient Environment Action Team process was entirely self-assessment). The Department of Health has advised that Patient-led Assessments of the care environment assessments should also include an external validator. External validation, in this context, means that an individual with experience of the patient assessment process attends the assessment at another organisation to observe the process and ensure that it is conducted in accordance with published advice, guidelines and recommendations. Such individuals do not normally take part in the assessment and would not count as a Patient Assessor for the purposes of ensuring a minimum of 50% of assessors were from outside the organisation being assessed. Patient-led Assessments of the Care Environment inspections are voluntary, but in the first year (2013) every single eligible NHS hospital and well over 200 independent sector hospitals took part. The results are used by the Care Quality Commission in their risk assessment of sites prior to inspection. Importantly, the principle of this recommendation will also be met through the new functions of the Chief Inspector of Hospitals and Care Quality Commission’s inspection regime. The Chief Inspector of Hospitals is expected to provide an honest and independent assessment about how well or badly hospitals are serving patients and the public. Expert inspections are envisaged whereby inspectors will be specialists in the areas they review; and judgement will be based on first-hand expert experience combined with data and feedback from patients and staff. 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.


As stated in our initial response, Patient-led Assessments of the Care Environment replaced Patient Environment Action Team inspections early in 2013. Fieldwork for the 2014 round of Patient-led Assessments of the Care Environment assessments was carried out between February and June 2014 and the outcomes were published by the Health and Social Care Information Centre in August 2014. The Health and Social Care Information Centre also provide additional support for independent reviews through making available a list of volunteer independent reviewers. The Care Quality Commission calculates an overall trust Patient-led Assessments of the Care Environment score that incorporates the scores for each of the four domains to assess the final risk for the Patient-led Assessments of the Care Environment indicator within Intelligent Monitoring since July 2014. The Care Quality Commission is still happy to provide a representative to support Patient-led Assessments of the Care Environment assessments should NHS England seek its input.