INSPECTORS will scrutinise staff levels in Scottish hospitals for the first time in a major shake-up outlined by the nation's health service watchdog.
Accident and emergency departments, maternity care and GP services would also be subjected to careful checks as part of new comprehensive quality and safety assessments proposed by inspection body Healthcare Improvement Scotland (HIS).
The creation of a Healthcare Intelligence Review Group, to gather information about where health boards are struggling, is also on the cards.
It would take feedback from patients and the findings of complaint investigators the Scottish Public Service Ombudsman, and could also use calls made to the recently launched whistle-blowers' helpline, when deciding where to send inspection and improvement teams.
The proposals have been published by the inspection organisation following a damning review of care in NHS Lanarkshire last year. The review was sparked by high death rates.
When HIS investigated the hospitals in the region it identified gaps in medical cover, nurse shortages, inadequate checks on deteriorating patients and a number of other issues.
HIS already oversees inspections that look into hospital cleanliness and the way elderly people are cared for on wards.
This year it is expanding to assess the care of patients suffering from the most common cancers for the first time in a bid to ensure better survival rates.
However, the new plans - which are currently out for consultation - expand the role of inspectors much further.
The organisation says the new quality and safety assessments will look into a list of crucial NHS issues.
As well as staffing levels and community care, this includes the way patients are discharged from hospital and the way health boards manage adverse events - incidents that have resulted in patient harm.
The Royal College of Nursing Scotland has welcomed the proposals.
Theresa Fyffe, RCN Scotland director, said: "We have been saying for some time that patient care can be compromised if there are not enough nursing staff, working at the right level, to provide safe, high-quality care.
"Indeed, RCN's recent employment survey in Scotland found that more than half [of nurses] are under too much pressure at work and 55% report being unable to provide the level of care they want as a result of pressure.
"So we welcome this consultation from HIS into its proposed areas for scrutiny and assurance in 2014/15 and will be responding in full to it."
Questions about the independence of HIS were raised last year when it emerged that a draft report on elderly care at Ninewells Hospital in Dundee had been shelved after staff were shown a copy and disagreed with some of the comments.
Regarding its inspections of elderly care, the new consultation document says: "We will increase our dialogue with NHS boards throughout the scrutiny process."
It also talks about creating a panel of clinical experts who will meet NHS boards before each inspection.
However, HIS says the inspections will take place without warning - they could take place up to six months after the expert group meeting and would be unannounced.
Robbie Pearson, director of scrutiny and assurance for HIS, declined to be interviewed on the planned changes. However, in a foreword to the consultation, he says: "As a scrutiny body of the NHS, rather than a regulator, we work closely with NHS boards to inspect and review their services and work with them to apply evidence and provide appropriate improvement support."
A Scottish Government spokesman said: "Scotland already has a robust scrutiny regime in place across NHS Scotland and the care sector, and we have confidence this system is continuing to drive improvement.
"However, we recognise there are always areas where the system could improve and that is why Healthcare Improvement Scotland carries out a yearly consultation on how the inspection process operates.
"This year this includes looking at plans to make changes to the system that would see it become a more comprehensive system, which would further embed the views of patients and carers in the inspection process."