More hospital trusts are failing on child protection, warns watchdog

More NHS trusts admit they are failing to comply with child protection guidelines, the government’s health inspectorate reports today.

Although more than 94% of trusts say they are meeting the standard, the figure is down 3.1% on last year, according to a report from the Care Quality Commission (CQC), which also warns that fewer trusts are ensuring patient confidentiality is preserved.

The decline in standards in key areas has alarmed the commission, which has warned trusts that it may have to impose “strict conditions … on their licence to operate”.

Publication of self-assessments by all 392 trusts in England comes amid growing concern over their accuracy. Three out of four London hospital trusts involved in the catalogue of errors that led to the death of Baby P in 2007 had previously declared they were enforcing the relevant child protection standards.

Opposition parties have blamed government reforms for creating a maze of bureaucratic targets. The commission insists that its certification process subjects claims submitted by hospitals to close scrutiny.

“[We] will take a view on whether the declarations are accurate after carrying out a rigorous cross-checking exercise using thousands of items of performance data, information from patients and the public and inspections,” it stated.

The regulator is introducing a registration system next year, meaning that all health and adult social care providers must meet established criteria.

Legislation for the system comes into force in April 2010. Technically, it provides powers for any NHS trust to be ordered to stop treating patients and be deregistered, but it is highly unlikely such a disruptive measure would be taken.

Lesser penalties, however, include warnings, fines, the imposition of management changes and prosecutions. Private health providers are already subject to many of these controls.

NHS trusts have already had to register with the commission in relation to infection-control regulations; a total of 22 trusts have had restrictions and warnings imposed on them this year.

The CQC is concerned that only half of trusts said that they met all the standards and that there was “significant variation between regions”. Mid Staffordshire NHS trust, for example, which was the subject of a damning report earlier this year for pursuing performance targets to the detriment of patients, has declared that it has met almost all of the latest standards. More than 400 patients died than would have been expected between 2005 and 2008.

In its report the commission highlights areas where fewer trusts “declared compliance compared to last year”.

As well as fewer trusts following national guidance on child protection measures, there was a 2% fall in the number of trusts declaring that they have systems to ensure patient confidentiality. The total is now down to 96%.

Similar falls in standards were recorded on staff employment checks, learning from patient safety incidents and acting upon safety alerts within required time limits.

The latest data shows more trusts than before are now meeting infection control requirements – 80% declared compliance with the three standards relating to infection control.

A total of 10 organisations declared non-compliance with all three of the hygiene code standards. Cynthia Bower, chief executive of the CQC, said: “These declarations are an important piece of the jigsaw when it comes to building a picture of NHS performance.

“But it remains concerning that all trusts aren’t meeting core standards on safety and quality, five years after they were introduced. We will not hesitate to place conditions upon trusts’ registration, as part of our new statutory powers.

“It is often good news when a trust owns up to a problem because that suggests they have taken the first step to getting it sorted.”

Jo Webber of the NHS Confederation, which represents most trusts, commented: “There is a great deal that is improving in the NHS. However, there is still considerable room for improvement and the service recognises that.

“Nine out of 10 trusts have met at least 90% of the performance standards expected of them, and although only half are currently meeting all of their requirements it is important to remember that it was only a third as recently as three years ago.”