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CQC reports on pressures in the health and care system

The 2018/19 State of Care report from the Care Quality Commission finds a health and care system within which people can struggle to access the care they need, which puts pressure on other parts of the system. More integrated care across the entire system is needed and the report finds that when local health and social care providers work well together, the experience of care can be improved. 


The relentless year-on-year rise in attendances at emergency departments and acute hospital admissions noted in last year’s State of Care report has continued. Urgent and emergency services are struggling to provide high-quality care, with 44% rated as requires improvement and 8% as inadequate.


July 2019 saw the highest proportion of emergency patients spending more than four hours in A&E than any previous July for at least the last five years. What used to be a winter problem is now happening in summer as well. While other hospital services improved slightly this year, the quality of care in NHS urgent and emergency services in hospitals has deteriorated.


Problems in primary care and the social care system that mean people cannot easily access the care they need are directly impacting these pressures on A&E. In the 2019 GP Patient Survey, almost 1 in 8 people who did not take the appointment offered to them went to an emergency department instead.


Despite this, overall the majority of NHS hospitals have continued to provide good care during 2018/19, with 65% of NHS acute core services rated as good (up 5% since July 31, 2018) and 7% rated as outstanding. However, 25% of acute core services are rated as requires improvement and 2% (43) as inadequate. 


The report highlights that the challenge for government, Parliament, commissioners, national organisations and providers is to change the way services work together so that the right services are being commissioned to deliver what people need in their local area.


In a blog, Ian Trenholm, Chief Executive of the Care Quality Commission says: “In this year’s State of Care 2018/19 report, we found that too many people can’t get access to the right care at the right time and that services are struggling to cope with increased demand.


“Despite these challenges around demand, and the significant funding and workforce pressures felt by sectors, good quality care has largely been maintained. We should recognise the hard work of staff and volunteers who care for people across health and social care services.


“I want to particularly highlight the providers who are working together in new ways that not only improve quality but are giving their teams more development opportunities and flexibility to work across different settings, supporting them to deliver great care.


"However, whilst most care is good, too many people are unable to access good care when they need it. Some people are being pushed into wholly inappropriate care settings, such as emergency departments when they are not able to get the care they need locally."


The State of Care report also places a focus on the deterioration in mental health services, with poor care provided by unqualified staff or people without adequate training, skills, experience or clinical support to care for patients with complex needs.


Some people are detained in mental health services when this might have been avoided if they had been helped sooner, and then find themselves spending too long in services that are not suitable for them.


Too many people with a learning disability or autism are in hospital because of a lack of local, intensive community services.


The CQC raises concerns about the quality of inpatient wards that should be providing longer-term and highly specialised care for people. It has also shone a spotlight on the prolonged use of segregation for people with severe and complex problems who should be receiving specialist care from staff with highly specialised skills, and in a setting that is fully tailored to their needs.


Click here to download the full report.