State of care report highlights improvements but warns of tough times ahead

In the years leading up to the implementation of the Health and Social Care Act 2008, health and social care services have improved, says CQC in its latest State of Care report.

The Care Quality Commission (CQC) today publishes its second annual report to Parliament on the state of health care and adult social care in England. CQC will publish later this year a further report which looks at health and social care after registration under Health and Social Care Act 2008.

CQC highlights improvements in the care system but says there are still some areas which have not improved fast enough, and stresses that it is vital that the advances already made become a key component of the newly emerging care system.

The report shows that people have greater control over their care due to more choice in areas such as appointment times, choice of location of care and choice of providers. However, it notes that while more people had access to personalised services through direct payments or personal budgets, there is still a wide variation in progress across the country.

The Commission community mental health survey found that mental health services varied greatly in the extent to which they involve patients in planning their care and reviewing their treatment. CQC’s own Commissioners found that many services need to substantially improve their practices; a particular area of concern was that many detained patients who were certified as consenting to treatment, appeared to be refusing to give consent or lacked the capacity to do so.

CQC also found that the quality of private-sector run care services is generally lower than those run by councils or voluntary originations. In April 2010, services run directly by councils and those run by voluntary organisations had the highest proportion of services rated good and excellent (91%), however they have a smaller fraction of the market. Whereas privately run services had a significantly smaller proportion of good and excellent ratings (81%) than other sectors, although this was a significant improvement on May 2008.

CQC’s chair, Dame Jo Williams, said: “There have been significant improvements in outcomes for people who use services and these services should be congratulated for the work they have done. However, the overall picture is far from perfect and it will be vital for all parts of the health and social care system to continue this upward trend and consolidate the best of what has worked well for people who use services.

“The next few years will be a crucial time for health and social care in England. There will be important changes such as the creation of HealthWatch, Monitor as the economic regulator for health and social care, GP led commissioning consortia, Health and Well Being Boards and the National Health Service Commissioning Board.

“We hope that in the future, service providers and commissioners don’t lose sight of the good work that has already been done. The truly good care is care that is centred around the individual and tailored to their needs.”

Dame Jo added: “We have now introduced a new system for regulating health and social care providers using the powers that we have under the Health and Social Care Act 2008. The new system of regulation works much more in real time, which allows us to respond more quickly to poor standards of quality and safety where they are identified in order to improve outcomes for people who use services.”

The report’s main conclusions are: 

Overall there has been major improvement, including in areas that really matter to people. Waiting times for NHS Hospital treatment have shown progress, with the percentage of admitted patients treated within 18 weeks increase up 48% to 86% between March 2007 and March 2008.

Safe care homes – There was a substantial increase in the number of care homes and home care services meeting safe care standards, including safe working practices and hygiene and infection control. However, the report finds that further improvements of medicines management is still needed.

Quality of council commissioning – The quality of care arranged by councils between September 2008 and September 2009 improved, the percentage of people supported in care homes that were rated good or excellent improved by 11%; and 6% for home care agencies. Councils also made significant improvements in adult safeguarding and in maintaining the dignity and respect of people who are in a vulnerable position by commissioning better care.

But some organisations still lag behind the pack and there are areas in which services frequently struggle to meet standards. Key areas of concern highlighted by CQC are:

Safe Care – Too many patients – as many as 40% said they were not told what danger signals to watch for after they went home from hospital. Around 45% reported that they did not have enough information about the side effects of medication.

Choice and control – Care services showed insufficient improvement in meeting standards relating to choice and control, this has been particularly prevalent in practices observed by our mental health Commissioners. Health commissioners were finding it difficult to balance spending on prevention while funding services for people with high level needs and some mental health services applied security measures in ways that placed unnecessary restriction on autonomy or compromised privacy.

Person-centered services – Councils found it challenging to extend further options for independent living, and community based services have been reduced. The rapid growth of demand for support, especially due to the rising number of older people, has not been matched by growth in the availability for more person centered support. The number of people over 75 who had repeated emergency admissions increased, suggesting a lack of effective community support.

Standards of care and support – The quality of some mental health inpatient services continued to cause concern, for example where the Commission observed over-occupied inpatient wards, lack of one-to-one work with patients, or unnecessary restrictions of liberty.

The full report can be found here: