Should we pity hospitals when an inspector calls?

Western Infirmary, Glasgow Picture: Stephen Sweeney

Western Infirmary, Glasgow Picture: Stephen Sweeney
You’ve got to feel a bit sorry for Glasgow’s Western Infirmary. Last week the hospital was in the news for all the wrong reasons as a report of its care of older people had been less than flattering.

Healthcare Improvement Scotland (the body that used to be Quality Improvement Scotland, and before that was the Clinical Standards Board – do keep up) has been charged by the Scottish government to carry out a series of inspections to “provide assurance that older people are being treated with compassion, dignity and respect while they are in an acute hospital”.

The first such inspection – at the Western Infirmary in February – found that, actually, that wasn’t entirely the case. Oh, overall it wasn’t bad news – or, as Susan Brimelow, the chief inspector put it: “Our inspection team noted areas where NHS Greater Glasgow and Clyde is performing well.” For example, staff and patients seemed to get on pretty well – at least I think that’s what she means by saying that “the majority of interactions we observed between staff and patients were positive”, which sounds like the way it should be.

But of course it didn’t stop with the positive – and, naturally enough, my friends in the Scottish media were (rightly) quick to pick up on the negative (as, indeed, I did myself).

Because, on the face of it, the negative was pretty bad. On nutrition, for example, which was a main focus of the inspection, there is definite room for improvement, with the report saying that “not all” nutritional assessments were being carried out on admission or during the patient’s stay, and that personalised plans, to meet individual patient needs, were consequently not in place.

This paints a picture of hospital patients – who are, by their very nature, vulnerable, and for whom decent food could literally mean the difference between life and death – not having their needs properly addressed.

On the plus side, however, reading the whole report it emerges that the forms were filled in for the majority of patients whose notes were inspected, and those taking part in a survey overwhelmingly said that if they needed help with the likes of utensils at meal times, this was given by staff.

You can be sure that if it was me, or someone close to me who wasn’t getting tip-top care, I’d be bloody furious and would probably kick up a hell of a stink. So why do I feel sorry for the Western Infirmary? Simple, it’s because they’re the first.

Over the next weeks and months we will get lots of other reports on older people’s care. Some hospitals might be – probably are, actually – providing much worse care than the Western Infirmary (where feedback from patients showed they enjoyed the food, for example, and found the nursing staff friendly and chatty). But I bet that after the first few, unless they throw up something really startling, they won’t get much media coverage.

Remember the Healthcare Environment Inspectorate? That’s the body set up in 2009 to tackle healthcare associated infections by a programme of announced and unannounced inspections. Its first reports were met with acres of media coverage – hardly surprising, as it did uncover some pretty shocking things.

But last week, just a day after the Western Infirmary report was published, the results of an unannounced inspection of Perth Royal Infirmary were put into the public domain.

As usual, there was a mix of good and bad news: NHS Tayside is “working towards complying with standards to protect patients, staff and visitors from the risk of acquiring an infection”, said the ubiquitous Susan Brimelow. But although the areas inspected were “clean and well maintained”, all was not perfect. NHS Tayside is “required” – that’s the strong term – to ensure that medics fill in documents around a system to reduce infection (actually really quite important that they should) and ensure good communication between estates and ward staff, again pretty important.

Quite possibly there has been some media coverage of this report – I’d hope at least the Perthshire Advertiser would do something – but a fairly extensive Google search (I even looked at the second page!) has failed to find anything at the time of writing.

So what does this show us about the value of inspection reports? Well, it suggests that it’s best not to be the first in line if you want to avoid negative headlines. It also indicates that the impact of reports dwindles with time. In a way, it’s an object lesson in being open and transparent – if you go looking for problems, you’re bound to find them (because nobody is perfect), but if you’re consistent about reporting them then they lose their shock value. Dare I even suggest they get a bit boring?

Some might question the value of such inspection regimes – after all, the most recent reports were fairly positive, with most people getting decent and dignified care. Would money be better spent elsewhere?

On balance, I think inspection has an important role – both as a means of rooting out bad practice and as a spur to keep up standards. It’s also a way that patients and the public – and concerned members of staff – can hold management to account; after all, the more open and transparent the regime, the easier to raise concerns. And even if journalists get bored with an issue, surely that shouldn’t mean their readers do.

That doesn’t necessarily lessen my sympathy for the Western Infirmary. But I suppose someone had to be first.

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