CQC inspection: on the road to excellence

So how has the provider of mobile surgical facilities prepared for inspection and ensured consistent performance?

Any Olympic athlete will tell you that the route to the podium hinges on a rigorous, disciplined process of repeated exercises under testing conditions. Eventually, a condition can be established and honed, ready to be put to the test under varying circumstances. Such a focus on discipline and process is replicated off the sports field and this approach has been at the core of Vanguard Healthcare’s preparations to ensure readiness for inspection by the Care Quality Commission (CQC). Having been inspected twice within in the space of seven months, during 2013, this article examines how Vanguard successfully achieved the highest levels of CQC Registration. With the CQC recently publishing a report showing that no less than a quarter of NHS Trusts in England may be failing to provide safe care for patients, the importance of the inspection and registration process to the reputation of, and general public’s confidence in, a healthcare provider’s services cannot be underestimated. This is all the more pronounced in view of the Government’s drive to ensure ‘transparency’. Commenting on the recent short-list of ‘at risk’ hospitals, Health Secretary, Jeremy Hunt, said: “We want to share with the public so that they know what we know.” The CQC was established in 2009 to inspect and regulate health, social care services and local authorities in England, not limited to the public sector. This includes voluntary organisations, as well as private businesses like Vanguard Healthcare. Each care provider is required to be inspected against rigid criteria in order to demonstrate that they can, or are already, meeting the strict registration requirements. When the CQC took on the responsibilities of its forebears, The Healthcare Commission, Commission for Social Care Inspection and the Mental Health Act Commission, it was clear that things would be done differently and Vanguard were determined to use the opportunity to refine their already meticulous approach to process, audit and improvement. Mary Smallbone, Vanguard’s director of marketing and operations, commented: “For over a decade the NHS has been an important customer of ours, alongside other healthcare providers around the world, and we knew that when the CQC’s arrangements kicked in we would need to be ready from day one. We already had pretty sophisticated quality audit and procedural review processes in place, so adapting these for a new order of external inspection was something we were quite open to and relaxed about. That is not to underestimate the significant work involved in reviewing the CQC’s inspection criteria and comparing and where necessary adapting and aligning internal operating procedures.” Vanguard Healthcare has the world’s largest fleet of mobile surgical facilities, providing hospitals at home and abroad with completely fitted out interim surgical facilities, from temporary endoscopy units, right through to laminar flow airfiltered orthopaedic operating theatres. This includes the provision of nurses and operating department practitioners (ODPs) if necessary. At any one time, there could be as many as forty Vanguard units deployed at hospitals anywhere across the UK and continental Europe. The concept of Vanguard’s lorry-borne, 28 tonne ‘pop-up hospital’ has enabled hospitals to maintain clinical ‘productivity’ while they may be undergoing real-estate changes or refurbishments, or alternatively to increase the capacity of clinical services in order to bring down waiting times. The preparations, deployment and commissioning of a unit into a host hospital’s facilities is a complex but essential process, bringing together a huge range of activities and checks so as to guarantee, every time, a safe, clinically clean and efficient facility that can be seamlessly integrated into the host hospital’s internal procedures and patient pathway. These policies and procedures have been honed and developed over the years with almost military-style rigour across all areas of the deployment process, with hundreds of check-list items being reviewed before a site is cleared for operations, each logged and monitored in order to identify trends or intervene long before tell-tale signs become issues or worse still, problems. Vanguard’s first CQC inspection took place in the Spring of 2013, the company having received warning of the visit two months previously. The second visit, which took place in September, was unannounced, although in the case of both inspections, all of the hard work had been completed long before the first inspection. “When the general criteria for inspections were released shortly after the launch of the CQC, we spent many days reviewing in detail every area of our business, looking at the standards against which we would be measured. The starting point was to determine whether each standard applied to us, as we don’t actually own the patient pathway, but provide the facilities, environment and on most occasions a staffing element – nurses and ODPs. Once we had established which standards were relevant to our business we then spent time constructing a matrix of the standards and corresponding evidence to support each,” said Mary Smallbone, “and as we already had a comprehensive inventory of checks and audits, much of the work was about presentation rather than content, so that the data being reported on was presented in a userfriendly format for an inspector, but at the same time was useable as part of our existing reporting and information flow. In this way, we could eradicate duplicating processes and concentrate on harmonising them to be used for both.” Vanguard’s fundamental role and purpose is to provide the physical environment, the equipment on-board each unit, and clinical staff to support a mobile surgical solution for its client hospitals. These three elements formed the framework for inspection and quality controls, and can be reviewed and audited as distinct areas of work.

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