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28.11.18

Prof Ted Baker: The State of Care

Source: NHE Nov/Dec 2018

The CQC’s chief inspector of hospitals, Professor Ted Baker, discusses the findings of this year’s State of Care report and the need for local systems to work together to prevent growing ‘care injustice.’

This year’s State of Care report tells a story of contrasts. It highlights both the resilience and potential vulnerability of a health and care system where most people receive good care, but where access to care increasingly depends on where in the country you live and the type of support you need.

The report is the CQC’s annual assessment of the state of care in England and is based on an analysis of inspection findings and ratings of almost 30,000 services and providers, as well as external evidence such as staff and public surveys and interviews with people who use services.

The report shows that quality overall has been largely maintained from last year, and in some cases it has improved. For example, 60% of NHS acute hospital core services were rated ʻgoodʼ as of 31 July 2018, up from 55% at the same time last year. This is despite the continuing challenges providers face with regards to workforce, demand and funding, and demonstrates the commendable efforts of staff, leaders and carers in overcoming such pressures.

More than half (60%) of NHS hospital core services and 70% of mental health core services were rated as ʻgood.ʼ The hallmark of the high-quality care that we have seen is good leadership and governance, a strong organisational culture that embraces learning, and good partnership working – services looking externally to work with others and share what they know.

However, people’s experience of care varies depending on where they live, and is often determined by how well local services across sectors work together. This is something that we highlighted in our local system reviews, which found that ineffective collaboration between local health and care services can lead to people experiencing fragmented or poor care.

As a result, we see areas of the country where people may be less likely to access good care, more likely to experience ‘disjointed’ care, or only have access to providers with poor services. The consequence is ‘care injustice.’

Age UK estimates that 1.4 million (one in seven) older people do not have access to the care and support they need – an increase of almost 20% since 2015. Being unable to access vital care and support in the community is exacerbating the pressure on acute services, with people more likely to end up in hospital.

It follows that where we see a struggling acute trust, it is often symptomatic of the wider problems in the local heath and care system.

The most visible impact of this is the record breaking demand for NHS emergency care – which was once reserved for winter but is now a year-round issue. The findings of our hospital inspections show that urgent and emergency services are the core hospital service most likely to be rated as ʻrequires improvementʼ (41%) or ʻinadequateʼ (7%), and we have seen variation in the way that hospitals have planned for and managed increases in patient attendances.

Less obvious is the impact on people who use mental health services, many of whom may have to travel unreasonable distances to access the care and support they need.

Inappropriate out-of-area mental health placements vary considerably by region, and the CQC’s review of children and young people’s mental health services found that some children and young people were ‘at crisis point’ before they got the specialist care and support they needed – with average waiting times varying significantly according to local processes, systems and targets.

Spreading good practice

However, there is cause for optimism. In some places, people are benefitting from successful local initiatives and providers that are joined-up with a focus on individuals’ care needs.

The report includes examples such as integrated care hubs, where hundreds of people have avoided a hospital visit, and teams of care staff from different specialities working together to help people in severe pain.

For good care to be sustainable, it is no longer just about individual organisations succeeding or failing. When services work together with an understanding of the needs of their local populations, it is more likely that people will get the best care possible when they require it, and in the best environment that suits their needs.

To help make this happen consistently, we need to have a long-term funding solution for adult social care. Without this, the additional funding for the NHS risks being spent on treating people who have ended up in hospital because they couldn’t get the care they needed in the community.

Separately, there needs to be funding reform to support local systems to work together, and incentives for providers and commissioners to encourage collaboration. The alternative is a future in which care injustice will increase, and some people will be failed by the services that are meant to support them, with their health and quality of life suffering as result.

 

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