The Care Quality Commission (CQC) has today published its most comprehensive
‘State of Care’
report. The report examines all care sectors for the first time and explores
why some care services are failing to meet CQC
standards.
With
an increase in the number of people with complex or multiple illnesses, and the rising numbers of older people with dementia,
the report notes a growing demand for nursing care within social care settings.
This is reflected in an increase in the number of nursing homes
registered with CQC in 2011/12 (the
total rose by 1.4% [64 nursing homes] with a 3.3% increase in the number of
registered nursing home beds). At the same time, the number of residential
(non-nursing) care homes is falling.
Based on the
evidence of over 13,000 inspections, the report suggests that pressures on care services are increasing the
risks of poor or unsafe care for people who are less able to speak up for themselves
and those, who as a result of their circumstances, are more vulnerable.
The
report notes many examples of organisations that meet these challenges and
deliver an excellent quality of care. But CQC’s
inspectors on the ground also see others across both health and social care
that are failing to manage the impact of these challenges effectively, and delivering care that is task-based,
not person-centred. CQC’s Chief Executive David Behan says that this is
unacceptable.
The report concludes that in some areas staffing
and skill mix issues, combined with the need to care for people with
increasingly complex conditions, are beginning to affect the quality of care
being delivered, with a particular impact on the dignity and respect of people.
Where
services fail, CQC has found three common factors which contribute to the poor
quality of services:
- Providers
who try to manage with high vacancy rates or the wrong mix of skills.
- An attitude to care that is ‘task-based’, not person-centred.
- A care culture in which the unacceptable becomes the
norm.
The report focuses on whether people receiving
care – in the NHS, independent health care or adult social care – are treated
with respect and dignity. Of the 350 inspections of NHS hospital services CQC
carried out in 2011/12, 1 in 10 did not meet the standard on respecting and
involving people in their care (equates to 35 inspections). In social care, 15%
of the 2,502 inspections of nursing homes found a lack of respectful care
(equates to 375 inspections).
Ensuring there are enough staff to provide a good
service is a significant issue in many services. Of the 2,031 nursing homes
CQC inspected, 23% (equates to 467 inspections) were not meeting the CQC
standard of having adequate staffing levels, whilst 16% (equates to 603
inspections) of the 3,771 residential
care homes CQC inspected were not
meeting the same CQC standard. In
the NHS, 16% of 250 inspections of hospital services (equates to 40
inspections) failed to meet the standard.
The increased pressures on care providers are also
impacting on CQC standards – such as
record-keeping and the management of medicines - that can be tell-tale signs of
possible future problems of poor care.
The poor performance of some NHS hospitals in
both medicines management (where from 150 inspections, 21% - equates to 31
inspections - failed to meet the standard) and record-keeping (where from 153 inspections, 22% - equates to 33
inspections - failed to meet the standard) is an indicator of where standards may
slip as staff are stretched.
David Behan, Chief Executive of the CQC, said: “Our report
highlights concerns we have that pressures on some services are leading to problems
in the quality of care, keeping people safe, treating people with dignity and respect, and involving
people in decisions about their own care. These pressures can not be used as an
excuse to deliver poor care.
“Health and care services need to rise to the
challenge of responding to the increasingly complex conditions suffered by our
ageing population. That means delivering care that is based on the person’s
needs, not care that suits the way organisations work. It also means that
different services need to work well together in an integrated way that meets
the best interests of the people who use these services.
“CQC will use its increasing knowledge and
understanding, gained through thousands of inspections of services, to spot
growing trends that are directly leading to poor care. Where we find standards
are not being met we require improvements and we will use our enforcement
powers where necessary to tackle issues such as staff shortages or the failure
of service providers to involve people in decisions about their own care.”
