What we will inspect: NHS trusts

Our main approach is to carry out inspections of certain core services followed by an inspection of the well-led key question at trust level. But we will sometimes look at all core services (a comprehensive inspection) and sometimes just look at specific areas of concern (a focused inspection).

Types of inspection

Core service with well-led

These involve inspecting the five key questions in at least one core service, followed by an inspection of how well-led a provider is. We may also include an inspection of an additional service. The number of services that we inspect will therefore vary for each organisation. Most core (and additional) service inspections will normally be unannounced to enable us to observe routine activity. In some cases we may give a short notice period, for example when the service is delivered over a large geographical area or where we are inspecting a significant number of core services simultaneously.

The inspection of the well-led key question at trust level will follow the core service inspections. This will be announced on the first day of the core service(s) inspections to give us time to schedule the appropriate interviews. On-site activity will take up to three days. This assessment focuses on the well-led key question at trust level, and draws on our wider knowledge of quality in the trust at all levels.

Our assessment of trust-wide leadership, governance, management and culture will be the starting point for the trust-level rating for well-led. We also consider improvements and changes since the last inspection.

A small team of inspectors and specialist advisors with appropriate experience will look at a range of evidence applicable at the overall trust board level. This includes interviews with board members and senior staff, focus groups, analysis of data, strategic and trust-level policy documents, and information from external partners.

The scope and depth of our assessment of the well-led question varies for each provider. Our approach depends on factors such as the size of the trust, the findings of previous inspections, and information gathered from the provider, external partners and other sources on performance and risks in the trust across our five key questions.

Comprehensive

A comprehensive inspection is when we inspect all core services and all five key questions for each core service followed by an inspection of how well-led a provider is. The visit is announced and will usually last between one and four days.

Comprehensive inspections will only be triggered where we have significant concerns, for example if a trust is receiving mandated intensive support or where there has been significant change in the provision of services.

There will also be an unannounced visit(s) following the main announced inspection. This may be during the day or out of normal working hours and will often involve a smaller inspection team. We may re-visit areas we have already inspected. As with other inspections, at the start of the visit, the team will meet with the provider’s senior operations lead on duty at the time and we will feed back if there are any immediate safety concerns.

Focused

We may carry out a focused inspection when we need to respond to information about a concern or to follow up on the findings of a previous inspection. The inspection does not always look at all five key questions, but is focused on specific areas of concern.

Focused inspections may also happen when we have taken enforcement action. They are therefore smaller than comprehensive inspections, although they follow a similar process.

Focused inspections will normally be unannounced.

Inspecting complex providers and combined trusts

Where possible, we align our inspection process to minimise the complexity and increase efficiency for providers that deliver services across more than one sector for example, mental health, community health and care homes. We will use teams of specialists to inspect each of the services. For example, some trusts may provide a combination of acute hospital, mental health care, community health services and ambulance services, and may also run care homes or provide primary health care services. Also see how we rate services.

Use of resources

NHS Improvement carries out use of resources assessments for non-specialist NHS acute trusts. The assessment is of the provider’s overall use of resources, and is assessed only at the trust level (not for each core service or hospital location).

It includes an announced site visit by a team from NHS Improvement. These will be planned with the trust in advance and normally scheduled to take place before the corresponding CQC on-site inspection of the well-led key question at the trust level.

Use of resources assessments result in a formal rating for the trust’s use of resources and a report, which CQC reviews, approves and publishes on our website.

These assessments initially apply to non-specialist acute trusts, but NHS Improvement is exploring how it could also apply to specialist acute trusts and mental health, ambulance and community care trusts.

For more information about the approach, see the section on use of resources and the joint use of resources assessment framework.