State of Care report says no excuses for inadequate care

There is no excuse for the variation in the standard of health and care services which makes it an “unacceptable” lottery, the Care Quality Commission (CQC) said today.

The CQC, which checks whether hospitals, care homes, GPs, dentists and services are meeting national standards, said it was “calling time on unacceptable inadequate care”.

In its fifth annual report on the state of health and care services in England the inspectors identify a need for strong effective leadership at all levels, and a mounting financial challenge in health and adult social care.

The report – State Of Care – looks at the state of health and adult social care in England in 2013/14 and covers more than 40,000 care services.

Out of the inspections 60% of all hospitals (49 out of 82) needed improvement or were found to be inadequate while 40% were rated as good.

A clear positive impact was seen at care homes which had registered managers compared to those which did not.

In some cases, according to the CQC, it made a difference of up to 13% in terms of the care home meeting the regulations.

CQC chief executive David Behan noted there are many hard working staff in the NHS and that care overall is good but said there is “too much variation”.

If people are to be confident they will get good care then there is a need to close the care gap now, he said.

Mr Behan said: “But we have also seen very poor care, such as the care home that inspectors found smelling of urine and where residents were still in bed at 10.30am, with many not getting the help they needed to eat breakfast.

“In one hospital we found that patients who had undergone surgery were being cared for in the recovery area for extended lengths of time due to a shortage of surgical beds on the wards.

“Patients were being returned to clinical areas that were inappropriate given the complexity of their needs.

“Our inspections have also found variation within services. For example, while most hospitals are rated at least good for the way they care for people, the majority require improvement when it comes to keeping people safe.

“While we will celebrate good and outstanding care where we find it, we are calling time on unacceptable inadequate care.

“When our inspections identify poor care, they should be the beginning of a process of improvement for the provider, who should learn from the good and outstanding care we highlight through our new ratings.

“CQC is challenging every health and care provider in England, and every commissioner and oversight body, to deliver the high standards of care that each person has a right to expect.”

There is significant variation in the quality of adult social care, with people living in nursing homes often receiving much poorer care than those living in residential care homes, according to the CQC.

Encouraging more nurses to work in the care home sector should be a higher priority, it was stressed, as one in five nursing homes did not have enough staff on duty to ensure residents received good, safe care in 2013/2014.

The CQC also said it had concerns about 15-minute home care appointments and whether they can truly deliver care and support that is safe, caring, effective and responsive to people’s needs.

The CQC is now armed with new-style inspections backed up with a system of special measures in which providers are given timescales for improvement.

Its new powers should mean it can take quicker action when there is a failure to improve or immediate action is needed.

In terms of hospitals, mental health care and community health services, the first acute trusts to be inspected under this tougher approach tended to be higher risk.
Of the 38 acute trusts, nine were rated good, 24 needed improvement and five were inadequate.

Wide variations were recorded in care between trusts, between hospital sites, between hospital services and within each service – plus also from outstanding to inadequate.

Safety was the biggest concern, the CQC stressed, as four out of every five safety ratings were warnings that standards were inadequate or needed improvement.

Mental health care inspections unearthed problems with poor physical environments and a lack of admission beds.

The inspectors found that too many people who suffering a crisis in a public place were taken to police cells because of problems in finding a place of safety that could be provided by a mental health service or a hospital emergency department in a general hospital.

Last month Frimley Park in Surrey became the first NHS hospital to receive an outstanding rating.

Initial community healthcare inspections also found that most staff were compassionate and caring and patients were very positive about the quality of care they received.

Inspectors spotted some instances of good practice. This included an Accident & Emergency team which worked with patients to identify the type of support they needed and then followed this up with work to ensure those needs were met in the community. This meant that the number of patients who needed to be admitted to hospital was cut.

There was also a care home which ensure that supporting dementia was built into each care plan. In practice this meant that the night time care plan for one person reminded staff that the person had little concept of night and day, and needed to be reminded it was night time.

Mr Behan added: “There is a mounting financial challenge in health and adult social care but this should not excuse inadequate care.

“Many of the issues raised in this report will involve new approaches across the NHS. That is why we support NHS England’s plan, due to be published soon, for a five year forward view setting out why the NHS needs to change and what it needs to do in order to meet the needs of patients.”

Copyright (c) Press Association Ltd. 2014, All Rights Reserved.

A copy of the report is available here: