Safe delivery of care in acute hospitals inspection programme

The focus for our inspections are the factors that contribute to the safe delivery of care.

---

Summary

Our inspections are unannounced and focus on:

• infection prevention and control (including respiratory pathways)
• the care of patients
• staffing within clinical areas
• the systems and processes in place to mitigate risks in relation to the delivery of safe care.

We will inspect against:

• the Health and Social Care Standards (2017)
• HAI Standards (2015)
• the HIS Quality of Care Framework (2018)
• and any other standards that become relevant during the course of the inspection.

You can read a list of relevant national standards, guidance and best practice in our inspection methodology.

How we inspect services

During our inspections we will:

• observe the delivery of care within the clinical areas in line with current standards and best practice
• attend hospital safety huddles during the course of the inspection
• report on the standards achieved on the day of our inspection
• ensure the NHS board produces an action plan to address the areas for improvement identified
• engage with staff where possible being mindful not to impact on the delivery of care, and
• engage with management to understand current pressures and assess the compliance with the NHS board policies and procedures, best practice statements or national standards, to provide assurance on the safety and quality of care.

We will identify any areas where NHS boards are required to take action. These are called ‘requirements’.

A requirement sets out what action is required from an NHS board to comply with national standards.

A requirement means the hospital or service has not met the standards. We are concerned about the impact this has on patients using the hospital or service.

We expect that all requirements are addressed and the necessary improvements are made.

We expect NHS Boards to address the requirements made as a result our inspections.

The NHS board must prioritise the requirements to meet national standards.

Following an inspection, the NHS board will create an improvement action plan. This will be available on our website along with our inspection report.

We will report our findings under our Quality of Care Framework domains and quality indicators. 

We will also consider the delivery of care in accordance with the Health and Care (Staffing) (Scotland) Act (Acts of the Scottish Parliament, 2019).