 Dear colleague
The state of health care and adult social care in England 2016/17
Today we have published The state of health care and adult social care in England 2016/17. This is our annual assessment of health and social care in England and looks at the trends, highlights examples of good and outstanding care, and identifies factors that maintain high-quality care.
This year's State of Care has shown that the quality of health and social care has been maintained despite some very real challenges. Most people are receiving good, safe care and many services that were previously rated as inadequate have recognised our inspection findings, made the necessary change and improved. The fact that quality has been maintained in the toughest climate most can remember is testament to the hard work and dedication of staff and leaders. However, as the system continues to struggle with increasingly complex demand, access and cost, future quality is precarious.
With the complexity of demand increasing across all sectors, the entire health and social care system is at full stretch. The impact on people is particularly noticeable where sectors come together – or fail to come together – as the complex patchwork of health and social care strains at the seams.
A great deal has been achieved in exceptionally challenging circumstances. We must now build on this in order to realise a future where people receive personalised, consistent, high quality care and are able to access that care when they need it - whether that's delivered in an acute hospital, a nursing home, a community mental health service, a GP surgery or a person's own home. We know that staff and leaders can't work any harder. Everybody's focus must now be on working more collaboratively – looking out, not just in – to create a sustainable and effective health and care system for the third decade of the 21st century.
Yours sincerely
Peter Wyman CBE DL (Chair)
Sir David Behan CBE (Chief Executive)
Our key findings
Health and care services are at full stretch
- Demand
for services is increasing in all sectors and the demand is getting more
complex.
- People
are stuck in hospitals, for example, waiting for a home care package or for
further NHS care. There are fewer
hospital beds available and people are waiting longer for treatment.
Ambulances are unable to respond to emergency calls because of delays
getting patients into A&E. Young people are detained under the Mental
Health Act because they cannot get the support they need in the community.
Primary care workload is growing with people's increasingly complex needs.
- There
is a growing burden on family and friends who are carers and don't get a
break.
Care providers are under pressure and staff resilience is not
inexhaustible
- All
health and care staff, and the services they work for, are under huge
pressure. The combination of greater demand and unfilled vacancies means
that care staff are working ever harder to deliver the quality of care
that people have a right to expect. However, there is a limit to their
resilience.
- More
people are talking openly about their mental health now, and seeking
treatment – there has been a steady rise in the number of people in
contact with mental health services over the last few years. At the same
time, the number of psychiatric nurses has fallen by 12% in seven years.
The quality of care across England is mostly good
- We
have inspected and rated all registered health and adult social care
services over a three-year period. The majority of the care that people
receive is good, and there are providers and services that deliver
outstanding care.
Quality has improved overall, but there is too much variation and
some services have deteriorated
-
Hard
work and determination from many providers and their staff has meant
people are receiving safer, more effective, and compassionate and
high-quality care – services have recognised our inspection findings and
made the necessary changes to get better.
- While
there has been much improvement, some services have deteriorated.
- There
are also substantial variations in the quality of care that people are
receiving – within and between services in the same sector, between
different sectors, and geographically.
To put people first, there must be more local collaboration and
joined up care
- To
deliver good, safe, sustainable care, more providers need to think beyond
traditional boundaries to reflect the experience of the people they
support. CQC will encourage the move towards coordinated care by
increasingly reporting not just on the quality of care of individual
providers, but on the quality of care across areas and coordination.
- Better
care is often where providers are working together to provide a more
seamless service, one that is built around the priorities of the services,
rather than people's needs.
Healthcare key findings
Hospitals, community health services and ambulance services
- Fifty-five per cent of NHS acute hospital core services were rated as good and 6% as outstanding (6%). This compares with 51% rated as good and 5% rated as outstanding last year. At the trust level, 11 NHS acute trusts were rated as outstanding.
- A majority of community health services were providing good (66%) or outstanding (6%) care. Three of the 10 ambulance trusts were rated as good and one as outstanding.
- Pockets of poor care exist, even in services rated as good. We continued to see a large amount of variation in the quality of care of services within individual hospitals and between hospitals in the same NHS acute trust.
- The safety of NHS acute hospitals remains a concern
with 5% of core services rated as inadequate for the safe key question. Ratings
have improved though, as last year 6% of core services were rated as inadequate
for safety
- Staff recruitment and appropriate skills mix were a concern in most sectors. We found NHS acute services relying too much on agency staff, and emergency departments with not enough medical staff. We have concerns that community and ambulance services are also facing staffing challenges.
- We continued to find that good leadership from senior leaders through to frontline staff, combined with strong staff engagement and a positive organisational culture, helps to ensure good quality care and drives improvement.
You can read the full chapter on our assessment of hospitals, community health services and ambulance services here.
Mental health
- We rated 68% of NHS core services as good and 6% as outstanding. Among independent services, 72% of core services were rated as good and 3% as outstanding.
- Twenty-four per cent of NHS core services were rated as requires improvement as at 31 July 2017, as were 23% of independent core services. And a small number were rated as inadequate: seven core services (1%) in NHS trusts and four core services (2%) among independent services.
- We are concerned about the high number of people in ‘locked rehabilitation wards’. Too often, these are in fact long stay wards that institutionalise patients, rather than a step on the road back to a more independent life in the person’s home community.
- We are concerned about the very wide variation between services in how frequently staff use physical restraint in response to challenging behaviour. Wards where the level of physical restraint was low had staff trained in the specialised skills required to anticipate and deescalate behaviours or situations that might lead to aggression or self-harm.
- We found some excellent examples of staff enabling patients to access GPs, dentists and healthcare clinics, and promoting physical exercise and healthy eating. However, we also found community mental health services where staff did not ensure that patients had their annual physical health checks.
You can read the full chapter on our assessment of mental health services.
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