5 things we learned from the new State of Care report

Mental health and adult social care services have been hit especially hard by cuts


The Care Quality Commission (CQC) has published its annual State of Care report today, an overview of health and adult social care in England. Here’s what you need to know:

It’s not all bad news 

The report states that ‘despite increasingly challenging circumstances, many services have managed to either improve or maintain quality’. More than 80 per cent of GP practices and 60 per cent of adult social care services inspected by the commission have been rated as good or outstanding.

The picture is worse for hospitals though; only 1 per cent were rated outstanding and 34 per cent good. Over half (57 per cent) required improvement and 8 per cent (12 hospitals) were rated as inadequate. The graph below (click to zoom) shows overall ratings by sector:

(But where it’s bad, it’s very bad)

The report describes some of the services rated inadequate (7 per cent overall) as ‘shocking’:

” We have been surprised at just how very poor some of this inadequate care is”.

Examples of problems noted in these services include A&E patients kept on trolleys overnight in a portable unit without proper nursing assessments; an ‘overpowering smell of urine’ and mould on the walls of a nursing home; and patients at a care home exhibiting symptoms of overdose because staff had not administered medicine correctly.

Staff shortages are a big problem

The CQC’s 2014 NHS inpatient survey showed that more than 40 per cent of respondents said that there were sometimes, rarely or never enough nurses on
duty to care for them.

Staff shortages continue to be a problem: for example, the CQC have expressed concern that from September 2009 to March 2015 there was a 15 per cent fall in the total number of inpatient psychiatric nurses – the equivalent of 4,000 nurses.

The CQC found that a lack of permanent staff means trusts are continuing to use agency and bank staff to fill the gaps.There was a 27 per cent increase in spending on temporary staff between 2012/13 and 2013/1440, and this trend continued into 2014/15.

This can have a negative impact on patient care. In adult social care, for example, the CQC found that ‘a vital aspect of being well-led in adult social care is having a registered manager consistently in post’.

Many of the adult social care services rated inadequate reported difficulties in recruiting and retaining managers, leading to a lack of consistency and affecting the ability to plan for improvements.

Adult social care is buckling under the strain of cuts

According to the National Audit Office (NAO), statutory funding for social care has decreased by £4.6 billion over the last five years, a 31 per cent real-term reduction in net budgets

Community services have seen the sharpest reductions, ie. day care and home care. This has had grave impacts on patient safety; of adult social care services inspected by the CQC, a third required improvement for safety and 10 per cent were rated inadequate for safety. The report lists staffing levels and poor medicines management as factors contributing to this trend.

There are significant inequalities in the quality of care people feel they receive

The report found that White people are significantly more likely to report being treated with dignity and respect than Asian and Asian British people. This echoes the findings of the Cancer Patient Experience Survey 2014, which showed that White people are more likely to rate their overall care as excellent or very good.

Here is one example of possibly different treatment and the difficulties in measuring it: the CQC found that White people were ‘significantly more likely to
report that hospital staff had discussed whether they needed equipment or adaptations at home, compared with Asian, Asian British, Black, Black British or people who viewed themselves as being of mixed race’.

The report notes that while in this case it is possible that staff are not treating patients equally, it could also be the case that where there is a language barrier people do not understand what is being discussed with them. Either way, there are communication issues that need to be addressed.

There is also evidence that Black and Minority Ethnic (BME) staff receive more abuse from patients, relatives or the public than White staff. The highest percentage of White staff to report this in any trust was 40 per cent, whereas the highest percentage for BME staff was 50 per cent.

Mental health services need urgent improvement

Mental illness accounts for 23 per cent of the total burden of disease in England, more than either cancer or heart disease. But recent estimates show that spending on mental health services forms just 11 per cent of the NHS budget.

This translates into shortcomings in care, particularly for young people; the CQC found that on average, people under 16 spent an average of 300 bed days in adult mental health inpatient settings each month during 2014/15. This equates to at least 10 children being placed in inappropriate settings every month.

Ruby Stockham is a staff writer at Left Foot Forward

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