New care regulator commends NHS progress on infection control

3 April 2009

Trusts are urged to remain vigilant and strive for further improvement.

The Care Quality Commission today (Friday) commended the majority of NHS trusts for improving infection control. It pointed out that infection rates are falling and that many hospitals are continuing to strengthen systems for protecting patients.

In the latest measure to drive improvement, it registered for the first time 388 NHS trusts to provide care after carrying out an assessment of whether they meet government regulations for managing infection.

To carry out the assessment, it asked that trusts declare whether they were compliant with the regulations and cross-checked this with other performance information, including patient and staff surveys, findings from the Healthcare Commission's hygiene inspections, trusts' declarations against core standards for infection control, and rates of MRSA and Clostridium difficile infection.

While CQC registered all trusts, it made registration of 21 trusts subject to conditions, which are legally enforceable and must be met within agreed timescales or enforcement action will follow.

It urged all 388 trusts to remain vigilant, ensure they complete planned programmes of improvement, and regularly review their performance.

The CQC pledged to check vigorously ongoing compliance with the registration requirements. It is planning to inspect over the next year up to half of all NHS trusts providing acute, primary care, mental health and ambulance services.

The health and social care regulator reminded trusts that it has a new range of strong powers, including issuing warning notices, fines, prosecution or even forcing closure in extreme circumstances.

When following up, the CQC will pay particular attention in monitoring and inspecting non-acute services. Until now, hygiene inspections have targeted predominantly the acute sector, where most infections tend to occur.

Registration on healthcare-associated infection is the first step towards full registration on all basic standards, a regime that will come into force from April 2010.

Barbara Young, Chair of the CQC, said: "We know from recent decreases in rates of MRSA and Clostridium difficile that the picture on infection control is improving nationally. Most trusts have stronger systems to protect patients from infection than a few years ago, and trusts' boards are taking the challenges seriously. We commend them for that.

"Registration of NHS trusts based on healthcare-associated infection marks the first step in a new system to drive further improvement and ensure patients' safety. This was an opportunity for trusts to let patients and the public know that they are taking effective action to tackle these infections.

"The overwhelming majority of trusts provided the assurance needed to register. Our work with these trusts is ongoing. We will closely monitor their performance to ensure they continue to meet the regulations and make improvements when required. All trusts must remain vigilant and constantly review and strengthen their performance. This is a continued drive and we want to see standards raised further.

"In 21 trusts we need further assurance that they are meeting the regulations. We have placed rigorous conditions on these trusts' registration and will monitor them closely. While infection rates at these trusts are not necessarily higher, they can do more to strengthen their approaches to infection control and help prevent outbreaks. We will monitor their performance throughout the year and will not hesitate to use our enforcement powers to protect patients' safety where needed.

"This is only the beginning of our work with NHS trusts. We aim to ensure they strive for continued improvement and that patients receive the same consistently high service wherever they receive care."

The CQC placed conditions on 21 trusts' registration to ensure they make necessary improvements promptly. They fall into two categories:

• In 13 cases, the trust declared non-compliance with some registration criteria that CQC used for judgement. The CQC judges the improvements needed are important and, while it acknowledges that the trust is taking action, it was not sufficiently confident that all issues would be remedied by 1 April 2009.
• In eight cases, the CQC had evidence that the trust has failed to achieve required standards for infection control on repeated occasions, had a high infection rate and/or the Healthcare Commission identified substantial issues that represented a potential risk to patients' safety at an inspection last year. The CQC was not sufficiently confident that the trust had identified the improvements needed and/or would take prompt action.

The number of trusts with conditions will change in the future as trusts provide the assurance needed and have conditions removed, or the CQC gains new evidence that other trusts are failing to meet adequate standards.

Registration of NHS trusts in 2009/10 applies to:

• Acute trusts (both foundation and non-foundation trusts)
• Ambulance trusts
• Mental health care trusts (including learning disability trusts)
• Primary care trusts
• NHS Blood and Transplant

It does not apply to primary care trusts who only commission services, or services commissioned from independent providers, such as GP and dental surgeries.

To register, trusts must meet government regulations aimed to ensure that patients, workers and others are protected against the identifiable risks of acquiring a healthcare-associated infection, so far as is reasonably practicable.

During the process of reviewing their systems in the run up to registration, many trusts improved their arrangements for managing infections and have committed to continuing programmes of improvement.

The CQC will continue to monitor these trusts' compliance with the regulations closely and will, if necessary, take enforcement action to pursue continuing poor performers. It will check new data on all trusts as it becomes available, and will also inspect up to half of all NHS trusts.

Ten acute trusts, six primary care trusts, four mental health care trusts and one ambulance trust were registered with conditions. Four of these are foundation trusts. Some conditions are ongoing, such as keeping wards clean, while others have a deadline for taking action (ranging from one to eight months).

Trusts must submit evidence to the CQC that they have met conditions before deadlines expire. The CQC will visit trusts to gain this assurance where necessary. It will remove conditions when it is assured that the trust has taken all action needed and can continue to meet the regulations.

Next year, a wider registration system is being rolled out covering the regulation of the NHS, independent healthcare and adult social care. This single framework will cover the whole range of quality and safety issues. The system will be subject to full consultation over the next year.

• HCAI registration status of NHS trusts that provide healthcare directly to patients

Notes to editors

• On 1 April 2009, it became a legal requirement for all NHS trusts that provide healthcare directly to patients to register with the CQC. To do so, they must meet government regulations aimed to ensure that patients, workers and others are protected against the identifiable risks of acquiring a healthcare-associated infection, so far as is reasonably practicable. The regulations can be found at: https://www.opsi.gov.uk/si/si2009/uksi_20090660_en_1
• Five NHS trusts stated that they do not provide any services directly to patients and are therefore not applicable for registration. These trusts are: Brighton and Hove City Primary Care Trust, Hartlepool Primary Care Trust, Stockton-on-Tees Teaching Primary Care Trust, County Durham Primary Care Trust, and Middlesbrough Primary Care Trust.
• The launch of the Care Quality Commission and new registration system were part of the Health and Social Care Act 2008.
• The criteria used for assessing compliance with the regulations are listed in the new code of practice regarding HCAIs - the Code of Practice for the NHS on the prevention and control of healthcare associated infections and related guidance. A copy can be downloaded from Department of Health's website: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_093762