NHS Hospitals are warned about unannounced spot-checks

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Hospitals are being warned in advance of supposedly random hygiene spot checks, academics have claimed.

Researchers accused NHS hospitals of ‘gaming’ the system to get around what is meant to be a regime of unannounced cleaning inspections.

Health experts at Oxford University and the London School of Hygiene and Tropical Medicine said hospitals are beefing up cleaning rounds in the run-up to an inspection, and then letting standards slip afterward.

Unannounced spot checks were introduced 17 years ago to tackle widespread fears about superbugs such as MRSA and other acquired infections.

Since the inspections were introduced, alongside a systematic programmes of deep cleans, cases of MRSA have plummeted by more than 90 per cent.

NHS hospitals are 'gaming' the system to get around what is meant to be a regime of unannounced cleaning inspections, experts claim

Under the spot-check programme, every part of a hospital is examined by a specialist inspection team, in a process that takes up to a month. They are meant to be given no more than 48 hours’ notice.

Every hospital should be assessed at least once a year. The teams which inspect hospitals include patients as well as professional inspectors.

Every hospital should be assessed at least once a year. The teams which inspect hospitals include patients as well as professional inspectors.

But the new research suggests hospitals are being made aware of an impending inspection weeks in advance.

The scientists used patient surveys from 205 NHS hospitals across England and compared them to dates of cleaning inspections.

The data, which spanned three years from 2011 to 2014, revealed patients were up to 11 per cent more likely to report ‘excellent’ cleanliness in the month before a spot-check was due.

Professor Martin McKee, from the London School of Hygiene & Tropical Medicine, said: ‘This paper is the first to confirm what many have long suspected, that the current system of hospital inspections encourages gaming.

Unannounced spot checks were introduced 17 years ago to tackle widespread fears about superbugs such as MRSA

‘This raises questions about whether it is really fit for purpose.’

The researchers, whose work is published in the Health Affairs journal, found through Freedom of Information requests that some hospitals were being given up to five months’ advance notice of such inspections.

They also found in the weeks before spot-checks, some hospitals performed a series of detailed pre-inspection checks a few days beforehand, allowing them to address long-standing problems.

Lead author Veronica Toffolutti, from the department of sociology at the University of Oxford, said: ‘Our conclusion is clear, in any regulatory system, such as the NHS, it should be assumed that gaming will take place.

‘The system should, however, be designed in ways that minimise this, and apparently inspections do not serve this purpose.’

The pattern of increased activity before was more marked in hospitals using outside cleaning contractors than those employing in-house cleaners, according to the study.

The authors said this chimes with other research which suggests hospitals which outsource their cleaning services have higher levels of MRSA and other superbugs, meaning they have to work harder to get standards up to scratch when an inspection is expected.

They wrote: ‘It is widely believed that since staff members know when each inspection will happen, they are incentivized to make a special effort in the period leading up to it and then relax their standards after the inspection.

Since the inspections were introduced, alongside a systematic programmes of deep cleans, cases of MRSA have plummeted by more than 90 per cent

‘NHS inspections are a core element of the performance management regime designed to ensure that hospitals maintain high standards of quality.

‘This is especially important when services, including cleaning, are outsourced to private contractors to save money.’

‘Our findings have obvious implications for policy, given the importance of hospital cleanliness in the fight against antimicrobial resistance.’

A NHS Improvement spokesman said: ‘Patients expect that NHS care will be given to them in a safe and clean environment, and often when things aren’t up to scratch it’s patients and their families that notice quickly.

‘That’s why patient-led assessments exist alongside the professional clinical inspections offered by the Care Quality Commission.

‘Every trust has a duty to its patients to use this system to their benefit, getting feedback from local people about how well they provide patients with privacy, dignity, nutrition and a clean environment.

‘For the benefit of patients, trusts must maintain standards all year round including outside of inspection times.

‘However, the system used by the CQC provides robust, unannounced inspections which complement patient-led assessments and help ensure patients get the best quality available at all times.’ 

 

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