Privatization of Local Public Hospitals


Explain perspectives that stakeholders in health and social care have regarding quality. Discuss Stakeholder’s perspectives on quality care issues and outcomes.

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RUH or Royal United Bath Hospital gives or provides health care services to more than 50000 people in the Western Wiltshire and North East of Somerset. This case study is based on the inspection that was carried on the CQC. CQC conducted an investigation on this organization and found that there were some gaps in the system. The health care organization fulfilled most of the standards that is set be various organizations and government, but they were unable to cope with one standard.  The staffs failed to monitor and keep proper record of fluid intake of the patients. They had insufficient reports about the hydration in patients. This gave rise to an unfavorable circumstance, thus receiving notice to revamp their service.

The external and internal stakeholders are also affected by this unfavorable circumstance. Frontline staffs, employees and patients each have some degree of stake inside the operation of RUH. These stakeholders have their own perspective or views on the quality of the work. All the stakeholders are equally responsible to certify and guarantee the quality of the service and see that if all the standards are being met by the organization.

The organization should make some changes in their system and they should provide the employees and staff with proper training and better devices to monitor the patients. Internal policies and rules should be updated and analyzed by the hospital to ensure smooth functioning.

Prespectives Of The Stakeholders

The various stakeholders present in the hospital are care providers, staff and family of the patients. Many internal and external partners comprise the complete group of stakeholders within the RUT or Royal Trust Hospital. Each one of them has their own views on the quality of the system. The idea about quality may differ from one person to another; it mainly depends on the perception of an individual what he or she prefers.

Stakeholders mainly care with the quality of the service and see to it that if the hospital has all the necessary equipments required for smooth functioning (Aiura and Sanjo 2010).  They expect that method of treatment will be accurate, diagnosis will be precise and finally the outcome of therapy and treatment of patient’s wellbeing and health. When accessing the system of RUH, patients look forward to the quality of service and care from the care providers. With the advancement in technology, the partners as well as the patients want the team to share information or knowledge and notify one another while providing services.

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Role Of External Agencies

It is the duty of CQC or Care Quality Commission group to regulate or monitor all the services present in the hospital or the other service providers present in England. It is their duty to see if all the health care institutions are providing service according to the standards that are mentioned in case of safety and health. A set of 28 regulations are used by CQC to see if all the health care institutions carry out their work. It is the role of the inspector to see if all the standards are met by the health care organizations. It is their duty to ensure how the guidelines are being interpreted and implemented in various organizations, if any gaps are found in the system than enforcement notices are issued against the organization.

About Royal Trust Hospital, all the standards ought to a part of the structured framework that is carried out in the entire company. These standards should be a part of all the procedures and policies present in the company.  CQC is a regulator that works in partnership with various other organizations like SCIE, NICE, ISO and Health and wellbeing board.

SCIE: Social Care Institute for Excellence or SICE is present to improve the lives of individual who use health care service by providing them with knowledge and information. It provides the registered organizations with various services like training for staffs, review and evaluation of the services in the health care organizations, etc.

NICE: It was initially set up in the year 1999, as a special health authority. It was set up to reduce difference in the quality and availability of the care and treatments in NHS.

This partnership ensures that there is no chance of discord or disparity. This teamwork also takes into account that all objectives and aims are followed accordingly.  Once or twice in a year inspections are held on the registered organizations to check the quality of the services.

After such an inspection in RUH, CQC published a report listings all the findings in the organization. CQC issued a notice and gave them a period of 1 year to make some changes in their system. They were asked to make some changes in the service so that it can be according to all the essential standards. It is mentioned in the report that the frontline staffs were unsuccessful in providing one essential service. They failed to monitor the fluid balance data and hydration charts and therefore the stakeholders are now entrusted with the work to implicate and design an effective and robust method (Anand and Sinha, 2010). This new method will help them take control of some activities like; frontline staffs are provided with accurate devices that will help them to keep record of all the patients present in the hospital.

impact of bad service quality

No organization can perform well with poor service quality. Health care organizations are supposed to provide good quality service to its patients. If the quality of the service is constantly, low than it will have undesirable effects on the stakeholders of the organizations. Performing in this kind of situation will give raise to circumstances where the patients will be at a risk (HEWISON, 2010). Example: In the report presented by CQC, the staffs did not have complete information about the condition of the patients and thus creating a situation of jeopardy.  The frontline staffs did not maintain the accurate and updated records of the patients. This lack of information could give rise fatal conditions for the patients.  If this situation keeps on continuing in the same way, than it ultimately lead the patients to boycott appointments and treatments in the organization. The employees or staffs who are responsible for the mistakes could be penalized. The administration of the organization could be served notices from the court if they are neglecting the case.

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The report that was published after the investigation by CQC on RUH, mentioned clearly that the frontline employees were unable to gather and implement all the updated reports of the patients.  They failed to account all the details regarding fluid report.

RUH must implement good monitoring systems. The administration must provide all the employees with devices that can be used to monitor all the details about hydration and fluid charts of every patient. This will enable the staffs to do their job efficiently and avoid this kind of mistakes.

Standards Used In Measuring The Quality

Standard are required in local and organizational bodies to ensure that the organization meets the fundamental standards, which means people have their own rights to receive their expected facilities from the health and social care. Many local and organisational bodies they are CQC, NICE, NMC standards follow some popular standards.

CQC is responsible for making the fair and appropriate judgment. It is also responsible for making report on quality of social care (Torjesen, 2013). They inspect different care service in many different ways by providing services to those people who wanted to take services form it by simply do registration to their services. They used data and information from the feedback, which is given by the organization to make judgment. They were giving services to care homes, hospitals, clinics, community services etc. NICE is a quality standard that is also needed for a wide range of tasks, which include both local and national purposes to develop and improve the health care. It is important to defend the rights and encourage the importance of user services. It is important to respect the rights of user services to make sure that their behavior does not harm the other people. It has become important to build and maintain the faith and confidence of user’s service.

Make sure that people receiving good quality care that relies on the difficult set of responsibilities and association between organization, service users and provider like care quality commission, NICE etc.NMC (nursing and midwifery council) is the specialized regulatory body. It is used to protect the patients through the effective measures to ensure proper inspection of health care. They have excellent expertise for this task. They are capable of investigating all the relevant and private data by the special investigation from their expertise.

Standards That Can Be Used To Improve Quality

There are some popular standards that are followed by many local and organizational bodies, they are CQC, NICE, and NMC standards.CQC (Limb, 2013) is responsible for making the fair and appropriate judgment. NICE (Björkman, 2012) is a quality standard that is also needed for a wide range of tasks that include both local and national purposes to develop and improve the health care. It is important to defend the rights and encourage the importance of user services. It is important to respect the rights of user services to make sure that their behavior does not harm the other people.

Various Approaches In Implementing Good Quality Systems

Monitoring and measuring quality in place is helpful for any social and health organisations. The hospital should have proper measurements so that all the aspects of the organization can be determined.  Systematic process should be followed so that the quality of the organization can be efficiently maintained.

Many approaches that are used for implementing good systems. Some of them are national standards, local authorities and clinical guidelines.

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Measurements should be present in the hospital so that all the functions can be operated under systematic approach so that all the essential standards are met (Jones et al., 2010). Various approaches that can be used by the organization are as follows:

  • Structural measures: It is a type of framework that is used to monitor all the operations present in the RUH. It reviews the health sector like; work setting, information system of health, etc. The health care delivery and efficiency of the organization (Royal Trust Hospital) was not performing well. The frontline staffs were unable to provide the correct and accurate information about the patients, record keeping, give proper respect to the patients, etc. The organization must focus on the above factors and try to make some effective changes in them. Training must be provided to the staff and performance of the staff must be reviewed (Tingle, 2010).  The trainees in the organization must be given jobs that they are qualified enough to do, they should not be awarded with many responsibilities. The staff must be encouraged and good incentives must be provided, so that they will be motivated to do their work more efficiently.
  • Process measures: Indicators are used so that duties and performance are tracked. Indicators like capability based learning, ongoing and initial training that are used to quantify all the actions taken by the employees concerning their role. There are certain guidelines mentioned in the clinical sector, all these requirements should be met by the organization. Based on the evidence gathered and the outcomes of the patients are taken in consideration to see if all the requirements are met. At RUT the staffs failed to perform one task according to the guideline and thus they received a notice to rectify the mistake (Tingle, 2010). This mistake could have been avoided if the works of the employees were being supervised and the job description is clarified in a regular period.
  • Outcome measures: This is mainly concerned with the patient’s health and if there is any change (good or bad) in the health status. This status can be obtained by regular or periodic monitoring through statistics and studies. Example: Comparing and measuring the quality of treatment and care of patients who are suffering from type 2 diabetes is irrelevant. The period for this type of study will be tedious and will take a long time, and when the result will be delivered or obtained, it might have been obsolete or outdated.

All the above approaches can be beneficial for the organization because a constant monitoring of all the systems in the organization will take place. The status of the patients can be determined instantly and if  any fault is found can be rectified.

If the above measures are not implemented and the organization keeps on moving ahead with its old models and system, it might hamper their reputation. It is mentioned in the report that there was lack of information and it was caused due to the fact that each record was not effectively maintained. Therefore, if the authority does not rectify this gap then it might harm the organization and its patients in future.

The organization (Royal Trust Hospital) should focus on the final product of the service that is being provided by them. They should monitor the outcomes of the patients and provide the employees or staffs with good devices, so that they can monitor and keep record of all the patients.

Barriers In Imparting Good Quality Services

There are many difficulties found in the RUH, when a group of expertise makes an investigation in the local hospitals. Lack of quality health and social care services were found in RUH. Some difficulties like records were inaccurate and not updated regularly. There is lack of bed found in the inspection. The patients are forced to recover soon in order to make the bed space free and make available for the new patients. Ineffective data recording of the patient make the inaccurate diagnosing, which harms the health and trends to death. This type of activities creates barriers to any company procedures. Policies like medical record policy in 2008 that result bad media hype. An effective procedures are made by the government to overcome this barriers .CQC(care quality commission ) are made to look after and inspect the hospital, care homes and other care service to provide a good quality care service to the people who lived in England. The two different barriers are external barriers include inter-agency interaction, social policy and internal barriers that include risks, resources, interactions among peoples.

Cause Of Each Barrier

The cause, which makes the quality of social health care less effective, is lack of inter-agency interaction among the hospitals. They do not make proper policy to maintain the daily fluid intake of the patients. The lack of legislation like CQC (Debbie Brown and Hilson, 2014), NICE (Rees, 2010) which is necessary for the inspection of health care that whether they are providing the necessary facilities to their patients or not. These are the external barrier .The internal barriers are lack of resource provided by the hospitals like less beds, inaccurate data recording, lack of proper medication provided to the patients. The organization structure was poor and inadequate. There was no proper staff training that make the patient suffers a lot. The staffs were unaware of how to record the data. The people are less interactive that so that they cannot help each other to overcome this problem. They cannot communicate with each other how to solve this problem or to make complain to the managements.

 Impact Of The Identified Barriers

Poor health care service gives rise to undesirable events that make a bad impact on the stakeholders. Working under inadequate governance system is responsible for the inaccurate health care policy that suffers the most of the patients in the hospitals. The major risks that the people facing was, inaccurate data recording .The patients are forced to recover soon in order to make the bed space free and make available for the new patients. Ineffective data recording of the patient make the inaccurate diagnosing, which harms the health and trends to death. To prevent these activities it is very important to control the internal organization structure to provide the necessary thing. Regular monitoring is essential part against the local standard system.

Effectiveness Of Policies Systems And Procedures

It was mentioned in the report that there were some services that were inefficient. To make the system, policies and procedures effective, it is important to defend the rights and encourage the importance of user services. Make sure that people receiving good quality care that relies on the difficult set of responsibilities and association between organisation, service users and provider like care quality commission, NICE etc. It is important to build support that is necessary for joined up working between organization and experts. Hoisting the profile of social concern is important task in achieving quality in the service. There are various methods for estimating the quality of service in a health care, the national legislation like CQC, CCG, NICE (Adam Tairou and Martin, 2011) plays an important part in achieving quality in the services. The People were not protected form the risk of unsafe care and treatment that is done in many hospitals.

The royal united hospitals bath(RUH) is a NHS foundation trust providing accurate treatment to the people of town and villages in north east Somerset and western wiltshirethey which make a policy called hydrated policy in 2013 that looks after  whether all patients were getting the accurate fluid balance charts or not. The proper intake of fluid is important for the welfare of people health. By using this policy plan, the staffs are trained to check whether the patients were sufficiently hydrated or not. A good hydrated and fluid chart has been made from the multidisciplinary records. When the hydrated and fluid chart has not completed, the staff does not know about the intake of the amount of fluid taken by the patients. For example, it has been inspected that since three days a patient fluid intake record was at 15.00 on each day. The staff said that they forget to document what the patient had intoxicated.

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Methods For Evaluation Of Social And Health Care

The efficiency of services can be calculated by various techniques or methods, which should be used in a daily basis to ensure that the quality of the service does not fall. The assessment could be carried out by Clinical audit program to make sure of the efficiency of improvement cycle. Clinical audit involve assessment of the performance of health and social care services against all the standards. The clinical audit method can be used to measure effectiveness of the service. It involves measurement of the services against some proven and agreed standards. It accesses the feedback, need and experience of the patients and their friends and family.

Many methods that can be used to evaluate the quality of the services with respect to the external and internal stakeholders perspectives. The NICE, SCIE, CQC, RCN and many more legislations play a huge part in evaluating the quality.

SCIE is dedicated in representing the stakeholders by collecting evidence from various sources. It is their aim to improve support provided to the people and ensuring that all the services are of good quality. A set of strategies and principles are developed by SCIE, knowledge is analyzed and collated, providing proofs to support methods of improving the alertness and skills of trainers, , frontline staff and commissioners.

All the information is gathered by NICE utilizing their guidelines for quality. It provides accreditation the heath care practitioners.

CQC ensures the safety and quality of the care that is provided by carrying out reports and checks on the services that are registered.

Advantages: The various methods those are used by the organizations are effective enough to implement quality. RUH is a registered care provider, they are obligated to implement all the standards   those are necessary for ensuring quality.

Disadvantages: A scenario could occur where not all the details are available in the system. This lack of information can trigger uncertainty in the system.

Impact Of Involving Users

Service user’s participation has a colossal impact on services offer. Each patients share diverse perspectives and ideas, which aids health and social organization to spot the main areas of improvement.  Patients are becoming more involved in the delivery and design aspect now a days. This helps in the facilitation of social and health organizations to identify and improve their services.

The NHS trust believe that the involvement of the service user’s is necessary. The users of the services can be engaged in determining and influencing the system of the organization. It targets to make sure that everyone who uses the services are the center of attention.

Royal Trust Hospital can improve the quality of service by developing and improving the services. The report presented by the CQC shows that there are many gaps in the system of the hospital. They provide very poor quality of service to their patients. The organization must ensure that all the people those use the services are taken care of properly. The approach for service involvement and engagement in decision making was implemented in the year 2006 and upgraded in the year 2007. The efficient completion of the service user’s participation has positive impact on services as it can enhance the quality of the organization.


This essay is based on the various areas present in the RUH case study. Many aspects of this hospital is explained in this essay.  The perspectives of the stakeholders are explained in this essay and how the hospital can improve its condition. After a surprise investigation that was held by CQC in Royal Trust Hospitals, they found that the hospital passed on all the standards except one. The staffs failed to monitor the patient’s hydration report chart and thus gave in incomplete information about them. Various factors that are working against the development of the organization are discussed in brief in this report. The employees or staffs do not have good and proper equipments to monitor the records of the organization. Poor service and management can lead an organization straight into a hell whole sort of situation.

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