Service inspections: independent acute hospitals

This includes areas where patients receive more intensive monitoring and treatment for life-threatening conditions. These areas are usually described as high dependency units (level 2), intensive care units (level 3) or by the umbrella term, critical care units. Critical care should also include outreach services provided in other areas of a hospital.

The Department of Health and Social Care has defined levels of care (Comprehensive Critical Care, 2000). Critical care includes care at levels 2 and 3, including high dependency units. Some hospitals provide units for specific conditions such as renal or respiratory failure and spinal injury. The units are included in this service if they are funded as a high dependency unit and/or are led by a consultant intensivist.

This service includes all areas where people:

• undergo physiological measurements and diagnostic tests
• receive diagnostic test results

Diagnostic imaging includes imaging services and screening procedures, such as X-rays, fluoroscopy, MRIs, PET, CT and DEXA scans, ultrasound (including baby ultrasound that is not part of a maternity service), nuclear medicine scans, and mammography. It does not include children's diagnostic services, as these are covered under the children and young people service. The exception is where only children aged 16 years and over are seen, in which case these will be reported on under diagnostic imaging.

End of life care involves all care for patients who are approaching the end of their life and following death. A hospital may deliver care on any ward or as part of any of its services. It includes aspects of nursing care, specialist palliative care, bereavement support and mortuary services.

The definition of end of life includes patients who are 'approaching the end of life' when they are likely to die within the next 12 months. This includes patients whose death is imminent (expected within a few hours or days) and those with:

• advanced, progressive, incurable conditions
• general frailty and co-existing conditions that mean they are expected to die within 12 months
• existing conditions that put them at risk of dying if there is a sudden acute crisis in that condition
• life-threatening acute conditions caused by sudden catastrophic events

We inspect end of life care that relates to stillbirths under the maternity service. End of life care that relates to spontaneous miscarriages are also inspected under the maternity service.

We inspect end of life care services that relate to children and young people under the service for children and young people.

This includes all services for women that relate to pregnancy, with the exception of gynaecology, which we inspect under surgery services, and termination of pregnancy, which we inspect under the termination of pregnancy service.

However, the inspection framework for maternity does include ante and post-natal services, as well as labour wards, birth centres or units and theatres providing obstetric-related surgery.

A hospital can provide some of these services in the community setting, or they may be the responsibility of a different provider. We will look at the pathways between the two settings when we inspect.

If a new born baby requires treatment in a special care baby unit (SCBU) or neonatal unit where a paediatrician delivers the care, this comes under the service for children and young people.

This includes the broad range of specialties not included in the other services. In general terms, medical care includes those services that involve assessment, diagnosis and treatment of adults by medical interventions rather than surgery. Medical care also includes endoscopy services. Areas that we will inspect include:

• acute assessment units (also known as medical assessment units)
• general wards
• specialty wards, including gerontology (also known as care of the elderly) wards
• chemotherapy wards/suites
• endoscopy units/suites

Outpatient services include all areas where people receive advice or care and treatment without being admitted as an inpatient or day case.

It does not include children's outpatient services, as these are covered under the children and young people service. The exception is where only children aged 16 years and over are seen, in which case these will be reported on under outpatient services.

This includes all services for children between birth and up to the age of 18, including:

• inpatient wards
• outpatients
• end of life care
• all paediatric surgery
• the interface with maternity and community services
• paediatric intensive care units
• arrangements for transition to adult services

It does not include care provided in the emergency department, as this is covered under urgent and emergency care.

In cases where a location admits only children aged 16 years and over for surgery, then the surgery for this age group will be reported under surgical care.

In cases where only children aged 16 years and over are seen as an outpatient, then outpatient services for this age group will be reported under outpatients. The same principle applies for diagnostic and screening.

This service involves most surgical activity in the hospital. It includes planned (elective) surgery, day case surgery and emergency surgery. We inspect pre-assessment areas, theatres and anaesthetic rooms and recovery areas.

Surgical disciplines could include:

• trauma and orthopaedics (T&O)
• colorectal surgery
• general surgery
• urology
• ear, nose and throat (ENT)
• cardiac surgery
• vascular surgery
• ophthalmic surgery
• neurosurgery
• breast surgery
• upper gastro-intestinal surgery
• plastics and maxillofacial surgery
• cosmetic surgery
• thoracic surgery
• gynaecology
• hair transplant surgery

The surgery service also includes interventional radiology. We include some specialist surgery, including caesarean section, under the maternity service.

We will inspect independent clinics that carry out cosmetic surgery or hair transplant surgery under our approach to inspecting surgery in independent acute hospitals. By cosmetic surgery, we mean surgery carried out by a healthcare professional for cosmetic purpose where the procedure involves instruments or equipment inserted into the body.

This includes termination of pregnancy provided for all ages and incorporates ancillary activities that the provider carries out wholly or mainly in relation to termination of pregnancy. For example, sexual health screening, and assessing and determining the legal grounds for abortion. Termination of pregnancy refers to the treatment for terminating a pregnancy by surgical or medical methods, including feticide. Prescribing of abortifacient medicine is considered treatment for termination of pregnancy.

Urgent and emergency care refers to the service that people can access, without a referral, in an urgent or emergency situation. Its purpose is to treat patients presenting as an emergency or with urgent medical needs. Services include emergency departments, also called accident and emergency or A&E departments, and urgent care centres.

They may also include a clinical decision unit, ambulatory care unit, minor injury unit or walk-in centre. If the hospital provides an urgent care centre we will also include this in the inspection.

An urgent care centre may be located on one provider's premises but another provider may be responsible for it. In these cases the responsible provider must function effectively with the emergency department.

We will look at the care pathways between the two providers during the inspection.

Please note: in CQC's inspections, the treatment of children in the emergency department is part of urgent and emergency care. We do not consider it as part of the hospital's services for children and young people.