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NHS stands on ‘burning platform’ as trusts struggle to meet demands

A CQC report into the state of acute NHS hospital trusts has found that “unprecedented” levels of demand for services was leading to trusts suffering from “blind spots” where they were not able to provide quality care in certain core services.

The review, which inspected all 136 of the NHS’s acute non-specialist trusts and all 17 specialist trusts between September 2013 and June 2016, gives a detailed and comprehensive insight into the performance of acute NHS trusts.

Though the CQC did say that most hospitals were delivering good quality care, it warned that too often patient safety was neglected as there was not a reliable culture or systems put in place to ensure guidelines were always followed by staff.

There were also concerns surrounding the metrics that trusts used to measure the quality of care being delivered, saying that some measures on information like mortality rates was misleading and often were calculated in a way to “assure themselves [the trusts] about the quality of their services”.

Furthermore, the report also emphasised once again the damage that high bed occupancy rates for general and acute settings had remained very high and was having a negative impact on how effectively hospitals could run.

The inspectorate announced that occupancy was above the recommended level of 85% for rated acute trusts for every quarter since the start of 2014-15, saying: “Many hospitals face a daily struggle throughout the year to find suitable beds for both emergency and planned admissions.”

The report also highlighted the urgent need for change to hospital care, Professor Sir Mike Richards, CQC’s outgoing chief inspector of hospitals, said: “The NHS stands on a burning platform – the model of acute care that worked well when the NHS was established is no longer capable of delivering the care that today’s population needs.

“The need for change is clear, but finding the resources and energy to deliver change while simultaneously providing safe patient care can seem near impossible. What this report demonstrates, however, is that transformational change is possible, even in the most challenging of circumstances – we have witnessed it, and seen the evidence that it delivers improved care.

The CQC also stated that a move away from an “insular” approach to care and instead learning to share between organisations and trusts was critical to improving patient outcomes in hospitals.

NHS organisations welcome CQC report

Responding to the report, NHS Providers CEO Chris Hopson said: “This report sets out in detail the “unprecedented” challenge NHS trusts face in protecting and improving standards of care in the face of rapidly rising demand and severe financial constraints.

“Trust leaders will welcome the clear and honest acknowledgment that these pressures are “creating difficult-to-manage situations that are putting patient care at risk.

“Whilst the over-arching conclusion that transformational change is possible even in the toughest circumstances is encouraging, we need to be realistic about how long that change will take and how much investment and support it will require.”

Hopson also added: “We also need to be realistic about how much longer trusts can continue to operate in an environment with this degree of pressure.

“We welcome the emphasis on effective leadership, in developing organisations that have a culture of learning by listening to staff and patients. And we strongly endorse the praise for frontline staff, commended as “heroes” for their commitment and values.

“This was never more in evidence than in the last few weeks as the NHS has been stretched up to, and at times, beyond its limits, to deal with winter pressures.”

 We have been clear that the gap between what the NHS is being asked to deliver and the funding available is growing. But even in these most difficult of times NHS trusts are leading the way in developing new ways of working, resulting in better care for patients.

Hopson did say that though complacency about the NHS’ shortcomings should be avoided, the great achievements of the health service and its staff should not be undervalued, saying that NHS Trusts were “outstanding” and something to be celebrated.

Commenting on the findings, the Patients Association said that the warning was welcome, but that reports of “blind spots” in hospitals was worrying.

Katherine Murphy, outgoing CEO of the Patients Association, said: “We are pleased to see that many trusts have delivered transformational change that improves care for patients, even in difficult financial times. We encourage trusts to share experiences and in particular, good practice, across the NHS so that everyone can learn and improve together.

“Unfortunately, however, the report shows that most hospitals that have not delivered care to the expected standard and that there are patient safety ‘blind spots’. Disappointingly the CQC highlighted basic issues around patient safety such as hospitals not having effective systems in place to reduce hospital acquired infections.”

Murphy urged trusts to take not of the Patients Association’s recent study into reducing the number of hospital infections called Time to Act, also saying that it was disappointing that basic issues around patient safety were not being tackled effectively enough by a large number of trusts.

Responding to the bed occupancy rates, Murphy continued: “Activity within hospitals has increased year-on-year and bed occupancy rates for general and acute settings were consistently above the recommended maximum of 85% for rated acute trusts.

“Likewise, emergency admissions and outpatient appointments have risen at a faster rate in the year to September 2016 than in the previous year, which reflect changes in patient needs and expectations.”

She added: “We are also particularly concerned about the growing number of people waiting more than 18 weeks for hospital treatment, which we have previously raised as a concern in our 2016 waiting times report ‘Feeling the wait’.”

Murphy concluded by saying: “Unfortunately, as evidenced in this report the NHS has not been able to adapt and cope with this increased demand on services and as such is buckling under the pressure.  It is clear that these findings are alarming.

“We believe that what is required is a combination of clear, strong and innovative leadership within each hospital and an honest conversation with patients and the public about what the NHS is able to deliver in the face of growing pressures on our NHS.”

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