Interview with Professor Ted Baker, chief inspector of hospitals, Care Quality Commission

March 20, 2019 Guest opinion piece

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Ahead of this year’s GS1 UK healthcare conference, we were lucky enough to interview keynote speaker, Professor Ted Baker, chief inspector of hospitals, Care Quality Commission (CQC).

Here Professor Baker shares his thoughts on the latest national healthcare strategies, patient safety and the 2019 GS1 UK healthcare conference.

Within your current role as chief inspector of hospitals, what would you say is currently the biggest challenge trusts are facing when it comes to patient safety?

The biggest challenges are leadership and culture. These are the main underlying themes that need to change. The recent report we conducted on ”never events” drilled down on this. Culture is the core that needs to change if we are going to be able to keep moving forwards on safety.

Traditionally in the NHS, change has been enforced from the top down, but we need to, and are currently, shifting this towards more of a bottom-up approach. Staff on the frontline are more empowered and engaged, and leadership address the challenges being faced.

Staff have told us that they often feel there is a conflict between meeting operational pressures and ensuring safe care – they are too busy to initiate change – and this is where the problem lies. With cultural transformation and with good leadership, this can be overcome.

2019 has already been a busy year for healthcare with the NHS long-term plan and the launch of the Topol review. With the imminent launch of the national strategy for patient safety, where do you think the focus should be for trusts to make sure they are both equipped, and in a good position to drive these national plans forward?

These really are exciting times for the NHS. The release of the NHS long-term plan is bold, and it is welcome. From a regulatory perspective, this is a good thing. Similarly, the Topol review presents plenty of opportunities, but there are risks.

For example, there is a risk associated with the implementation of new technology. We need to be able to innovate quickly but the safety and practical aspects need to be considered beforehand.

With new tech in mind, human factors also need to be considered. Staff need to understand how systems and people interact and trusts need to take responsibility for training their staff to ensure they understand the safety dynamics.

A challenge for trusts is that there is an assumption that all clinicians have expertise around patient safety. Everyone recognises that safety is important, and clinicians are great at what they do but are not safety experts.

There needs to be a new and recognised level of safety expertise within trusts, and the launch of the national strategy for patient safety will prove to be a major change for the NHS.

It will enable us to start shaping a curriculum and develop staff expertise around a full understanding of safety – the healthcare sector does not operate like a high-risk industry in this regard. Everyone looks at it differently – from trust to trust and at an individual level – and we need national guidance in place to align our approach, based on the best expertise.

You’ll be speaking at the upcoming GS1 UK healthcare conference to deliver a presentation entitled: “Thinking like a high-risk industry - A regulator's view on driving standards within hospitals and the required human factors involved”. What’s the one key takeaway you want delegates to leave your session with?

One key message that came out of the report into never events was that the NHS needs to think more like a high-risk industry.

The healthcare sector needs to learn from industries such as nuclear and oil and gas – industries where safety is just as critical – and understand how these industries think about safety and have made major advances in safety in recent years.

We need to get clinicians to think differently about healthcare. At the moment, safety is more a task that clinicians have to fit in to a busy schedule rather than being a core requirement. High-risk industries know that errors will be made, but they have robust systems and processes in place to protect against the consequences of this.

The NHS is in an intrinsically high-risk field, and we need to focus on preventing safety incidents and learn from how to reduce risks when things do go wrong. Thinking about this differently is an essential step.

In order to improve, we need to remove cultural barriers in the way that healthcare thinks about safety and start to behave like other industries that have faced similar challenges.

What are you most looking forward to ahead of next month’s conference?

Meeting colleagues and hearing their views is always great, and this is what I look forward to the most. For me, it’s a great opportunity to share details of our focus areas at Care Quality Commission, as well as to find out about what healthcare professionals are working on within trusts.

It’s all about bringing everyone together to discuss core issues and this is where the value of the conference really come to the fore.

Looking forward, where do you think the biggest opportunities for healthcare lie in the next five years?

At the present time, the healthcare system is under significant pressure in many ways – increased workload, workforce limitations and financial constraints all play a part. Despite these challenges, we also have great opportunities to initiate change.

We can look at ways to innovate in how we use the workforce, looking at where we can make improvements. For example, the use of technology can help us to get the best out of our people, as well as helping us to provide safer and more efficient care.

Medtech and genomics will have a bigger role to play in the future, so there is a lot on the horizon. This is why the NHS long-term plan is so important – it takes into account the potential that a digitalised NHS has to offer, and gives us the opportunity to build on the aims it sets out.

We are already seeing a real change in leadership and culture across the NHS. There’s new energy in leadership and we are shifting towards better operational control instead of a top-down approach. It is all becoming less hierarchical.

Improving quality of care comes from the frontline and this is increasingly being recognised. There are some great organisations out there that are really leading the way on this and much of it comes from local work.

Services on the ground are improving and I am optimistic. CQC want to be an enabler helping to support and drive these continuing improvements.

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About Ted Baker

Ted was appointed chief inspector of hospitals at the Care Quality Commission in 2017. Previously, he has had extensive experience in clinical and academic medicine, in hospital management and as regulator.

He was deputy chief inspector of hospitals from 2014 and led the inspection programme for acute hospitals. Before this he had been medical director and deputy chief executive of Oxford University Hospitals NHS Trust, having previously been medical director of Guy’s and St Thomas NHS Foundation Trust.

Ted trained as a paediatric cardiologist and was in clinical practice for 35 years. He was a clinical academic at King’s College, London, and combined this with a series of clinical management roles.