Senior female woman patient in wheelchair sitting in hospital corridor with nurses and doctor

Care Quality Commission Annual Assessment of Health and Social Care

By John Tingle

The independent regulator for health and social care in England, the Quality Care Commission (CQC) has recently published its annual report on the real-time state of health and social care in England. It analyses trends, shares examples of outstanding, good, and poor health care care practices. It provides a true, unabashed account of issues facing the National Health Service (NHS) and health care delivery.

A Health System Stretched

There are commonalities, similar trends and challenges, found each year in the reports. A central message is that the NHS is stretched and is finding it difficult to meet current demands. This should come as no surprise. Ever since the NHS was founded in 1948 it has been short of resources and demand for services has always outstripped supply.

The report does acknowledge that the NHS must keep up with people’s needs today, and not as it was in 1948 when the NHS was formed: “Modern local services need to be designed around people’s needs that reflect society as it is in 2019-not as it was in 1948.”

Good Quality Care

Part 1 of the report gives an overview of issues and themes. The overall quality of care that people receive in England has improved very slightly from last year and most people receive good quality care. Many people, however, struggle to access care when they need it. Despite the care being good, they can face myriad challenges:

These challenges range across a spectrum. At one end, people may face inconveniences in getting appointments, chasing referrals and following up on previous visits. At the other end, people may be unable to get any help or service at all, compounded by difficulties in navigating their local health and care services and knowing where to turn.

The CQC state that there is variation in quality across England, which means that some populations in some regions may find it difficult to access good quality care.

The CQC notes “the relentless year-on year- rise in attendances at emergency departments and acute hospitals,” pointing out that “this trend has continued unabated over the last year, with urgent and emergency services bearing the brunt of this demand and struggling to provide high-quality care, with 44% rated as requires improvement and 8% as inadequate.”

Patient Safety, the Main Cause for Concern

NHS hospitals continued to provide good care during 2018/2019, with 65% of core services rated as good and 7% rated as outstanding. However, a cautionary note is sounded about safety, which remains the area of most concern for CQC, as 36% of services are rated as “requires improvement” and 3 % as “inadequate.”

Access to Care

Over the last year there has been an increase in referral to treatment times, with 4.4 million people at the end of June 2019 waiting to start treatment. This is an increase of 40% since June 2014.

The CQC report provides a valuable road map for the future delivery of good quality health care services. There are major problems identified, such as workforce issues and delays in accessing care. Worryingly, all these major problems can also translate into patient safety and litigation issues

John Tingle

John Tingle

John Tingle is a regular contributor to the Bill of Health blog. I am a Lecturer in Law, Birmingham Law School, University of Birmingham, UK; and a Visiting Professor of Law, Loyola University Chicago, School of Law. I am also a Patient Safety Specialist at ECRI Institute. I was a Visiting Scholar at Harvard Law School in November 2018 and formerly Associate Professor at Nottingham Law School, Nottingham Trent University in the UK. I have a fortnightly magazine column in the British Journal of Nursing where I focus on patient safety and the legal aspects of nursing and medicine. I have published over 500 articles and a number of leading texts in patient safety and nursing law. My current research interests are in global patient safety, policy and practice, particularly in African health care systems. My most recent publication is: "Global Patient-Safety Law Policy and Practice," edited by John Tingle, Clayton O'Neill, and Morgan Shimwell, Routledge 2018.

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