Comment

29.11.17

CQC: Beyond traditional boundaries

Professor Ted Baker, chief inspector of hospitals at the CQC, discusses the mixed findings of this year’s major State of Care report.

This year’s State of Care report presents an analysis of the quality of health and social care across the country based on the findings from our first full round of inspections with ratings. What these inspections have identified is that the majority of people are getting good, safe care despite some very real challenges. 

The report highlights that over 60% of NHS acute hospital services in England have been rated as good or outstanding, and that a number of hospitals have demonstrated improvements. Of those hospitals originally rated as inadequate, 67% have improved their rating to requires improvement, and 13% have improved their rating to good when CQC teams have returned to reinspect.

Unprecedented pressures

Variation in quality reflects the scale of the challenge that hospital trusts and other providers are facing as the changing nature of demand – increasing numbers of older people who are physically frail, many with dementia, more people with long-term complex conditions – is placing unprecedented pressure on the whole health and care system. Providers face workforce shortages in key areas and resources for investment are constrained.

So while there is much that is encouraging, we also know that over a third of hospital services need to do better, and although on the whole we have seen that the quality of care has been maintained, future quality is precarious.

Around 18% of hospitals originally rated as good have seen a decline in their rating, and in some instances we have found a large amount of variation in the quality of care of services in the same hospital and between hospitals in the same NHS acute trust.

While the majority of hospital services are delivering good-quality care and looking after patients well, our inspections have uncovered pockets of poor care even in good hospitals.

In acute hospitals, this means more people waiting over four hours at A&E, more planned operations cancelled and people waiting longer for treatment.

But the impact on people is particularly noticeable where sectors come together, or fail to come together: the teenager detained under the Mental Health Act because she’s been unable to access the support she needs in the community; the elderly man unable to leave hospital because there’s no home care package in place for him; the person who has had a stroke waiting for an ambulance that’s delayed because the crew are still waiting to get their previous patient into A&E.

Every part of the system must work together

To continue to deliver good, safe, sustainable care, more providers need to think beyond traditional boundaries to build care around the needs of current population and to reflect the experience of the people they support. All parts of the health and social care system must work together to provide a coordinated patient journey.

We are starting to see examples of where this is happening. At the end of March we published ‘The State of Care in NHS acute hospitals,’ which captured our findings over the last three years of our programme of inspections of NHS acute hospitals.

That report provides evidence of hospital trusts making practical changes to the way that care is delivered to work with the wider health and social care system to improve care and benefit patients.

Specific examples include GPs or nurse practitioners in care homes helping to ensure the frail and elderly are not being sent to A&E unnecessarily, and ambulatory care services that are allowing people to stay in their own homes while being supported to attend local clinics to get the treatment they need.

A shared vision for delivery

For this to happen more often and more consistently, leadership and support at all levels will be crucial. To truly coordinate care, local system leaders must ensure there is a shared vision of delivery, so that everyone involved can see themselves as part of the team that provides that care.

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 between these areas, reflecting how people access and experience this care.

Our findings will highlight what is working well and where there are opportunities to improve how the system works, enabling the sharing of good practice and identifying where additional support is needed to secure better outcomes for people using services.

This year’s assessment of the quality of health and social care contains much that is positive – the fact that quality has been maintained in the toughest climate that most can remember is testament to the hard work and dedication of frontline staff and leaders.

Tangible improvements

Many services that were previously rated as inadequate have recognised our inspection findings, made the necessary changes and improved. Safety continues to be our biggest concern, but we have also seen tangible improvements where providers have introduced clear systems of governance to enable learning and improvement from safety incidents, and encourage and support staff to raise concerns.

We are seeing exceptional leadership at all levels in trusts addressing sometimes longstanding problems. There is a new focus on organisational culture and engagement of frontline staff that is having a transformational effect in many organisations.

A great deal has been achieved in incredibly challenging circumstances. We must now build on this in order to develop a model of care where people receive a consistently good quality of care and are able to access appropriate care when they need it and where they need it.

Everybody’s focus must now be on working more collaboratively – looking outwards, not just inwards – to create a sustainable and effective health and care system for the 21st century.

 

FOR MORE INFORMATION
W: www.tinyurl.com/NHE-State-of-Care

Image © JohnDWilliams

Comments

Potkettle Black   06/12/2017 at 12:09

Over-regulation continues to be our biggest concern, and we have yet to see tangible improvements where regulators have introduced clear systems of governance to enable learning and improvement areas that are subject to multiple, redundant and costly systems of regulation. . To continue to deliver good, safe, sustainable care, more regulators need to think beyond traditional boundaries to build regulation around the needs of current providers and to reflect the experience of the systems they support. All parts of the regulatory system must work together to provide a coordinated regulation environment. Regulators' focus must now be on working more collaboratively – looking outwards, not just inwards – to create a sustainable and effective health and care regulation system for the 21st century.We are not yet seeing examples of where this is happening.

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