I work as a change management consultant in the UK healthcare sector and am also a healthcare consumer so I look at the activities of the CQC ('Clearly Quite Confusing'?) from two different perspectives. Here, I raise something that as a patient I do find clearly quite confusing.
It's this business of inspecting dental practices according to the so-called 'new approach' – i.e. against the fundamental standards – but, unlike most other healthcare services, not giving them a rating (in 2015/16 at least). I believe the thinking is that because the CQC only intends to inspect 10 per cent of England's 10,000 dental practices, rating them would (somehow) be unfair.
Frankly, I don't think this helps patients. Take for example one of the recent dental practice inspections on the CQC website. In the Overview, there is no indication of the quality of service. Instead, we must look to the 'Reports' tab. After some information about the practice and the inspections, there are six bullet points for 'key findings' and these all seemed positive. However, there are seven bullet points for 'areas where the provider should make improvements'. These included statements such as: 'Ensure that staff clean the boxes used to bring instruments to be decontaminated and then return them promptly to treatment rooms' and 'Ensure measures required by the Legionella risk assessment are carried out.' They sound rather alarming to me but how are patients to know if any or all of these are critical to their safety and wellbeing?
Now let's look at the 'Inspection summary' tab. There are sections on 'Overall summary & rating' (except there is no rating) and on each of the five fundamental standards. The text under each is essentially statements of act. So for 'Safe' we have: 'When any shortfalls were identified, prompt action was taken and the practice manager was aware that some improvements were needed in respect of infection prevention and control measures and the auditing of X-rays.'
However, when I looked at this same heading in the full (14-page) report I found rather more worrying statements such as: 'We observed that the blue boxes used to transport the dirty instruments had not been returned to the area of the treatment rooms reserved for collecting dirty instruments. Instead they had been stacked beside the clean boxes. Space in the decontamination room was limited so failure to return the boxes to the treatment rooms caused potential for cross contamination.'
There was more: until recently dentists had been re-using single use instruments, 'most' (therefore presumably not all) of the required actions following a professional Legionella risk assessment had been carried out, no record was kept of the temperature of the lockable medicines fridge and so on.
I might say 'the devil is in the detail'!
Clearly, the CQC inspectors had made a thorough inspection and compiled a comprehensive report but much of the impact is opaque to the general public. In other words, it is like trying to choose a hotel and being handed the full AA inspection report and denied the stars rating.
On the CQC website, there is a quote from Prof Steve Field, Chief Inspector of Primary Medical Services, "We know that the quality of care provided by most dentists is of an acceptable standard." Hmmm… hardly reassuring is it?
What I really want to see is ratings as per other regulated services. For example, searching the CQC website for the latest checks on doctors/GPs in Shropshire (my home county), I am delighted to see instantly lots of Good l and Outstanding P ratings.
For the latest CQC inspections look at 'Latest press releases' here: http://www.cqc.org.uk/content/news
About the author
Amanda Atkin is an experienced healthcare management consultant with extensive experience within dentistry from both clinical and managerial perspectives.
Her website is www.atkinspire.co.uk