Dismay as watchdogs see doctors treating patients

Members of the NHS Lothian Board said they feared the inspections could intrude on patient privacy and lead to wide-ranging conclusions being drawn from a small number of observations. They have also queried the level of training of the inspectors.

The scheme being operated by the Healthcare Environment Inspectorate (HEI) focuses on care of older people in hospital. The first inspection in the Lothians will take place at Liberton Hospital on December 8 and 9. In due course, similar inspections will be carried out on elderly care services at all acute hospitals in the Lothians.

Previously, hospital inspections focused only on cleanliness and infection prevention, but under the new inspections, hospital medical staff and patients will be observed.

At a meeting of the NHS board held last week, nurse director Melanie Hornett said they would involve: “Direct observation of care delivery, discussions with patients and their families, discussions with staff and review of clinical documentation and observation of the environment.”

She added: “There are also issues about how intrusive the inspection may be in terms of patient care delivery.”

Dr Alison McCallum, director of public health and health policy, said she had received assurances over the issue of confidentiality but was worried about conclusions being drawn from a small number of observations.

She said: “The number of people that can do it in the right way and can analyse this kind of data and provide robust analysis of its meanings is very small. I remain very, very concerned that we’re asking staff who have had very limited training to undertake something that normally takes a number of years to learn.”

And chief executive James Barbour told the board that it might find itself dealing with staff issues never before raised by inspectors.

He said: “These inspections, as I understand them, may well generate issues regarding the behaviours and professionalism of individual clinical professionals and they will have to be pursued at that level. That clearly raises issues.

“It will be difficult to generalise from the particular to system-wide issues. ”

A spokesman for Healthcare Improvement Scotland said: “We were directed by the Scottish Government to inspect the care of older people in NHS hospitals within Scotland.

“This is an extremely important set of inspections to independently ensure that the care of older people within our hospitals is the best it can be.

“The planned inspection process has been informed by clinicians with the appropriate expertise and will be undertaken by inspectors experienced at inspecting within health environments.

“Test inspections have been undertaken to ensure that the inspection process is robust and thorough.

“Patient and staff confidentiality will be an integral part of the process.”