The Care Quality Commission's (CQC) chief inspector of hospitals has warned that the NHS is now on ‘a burning platform’ and that patient safety is at risk due to ‘unprecedented’ demand.
In a report entitled ‘The state of care in NHS acute hospitals’, the CQC says that urgent action is needed to ensure the NHS is able to deliver safe and effective care for patients.
The report shows variation in the quality of hospital services – but also highlights those hospital trusts that have been able to make practical changes to the way they deliver care and are seeing improvements to patient care as a result.
This is the first time such a focused national analysis has been possible, following the introduction of CQC's new comprehensive inspection programme in 2013. Since then, CQC has completed inspections of all 136 acute non-specialist and all 18 specialist trusts, and now has a more detailed understanding of the quality of NHS care than ever before – at trust level, but also at an individual core service level.
Professor Sir Mike Richards, CQC's chief inspector of hospitals, said: "We have now inspected every hospital in England and have a unique picture of the quality of care, right down to individual core services. We have witnessed some fantastic care and examples of innovative practice, but we have also found a wide variation in quality both between hospitals and between services within the same hospital.
"What is clear is that while staff continue to work hard to deliver good care, the model of acute care that once worked well cannot continue to meet the needs of today's population. The NHS now stands on a burning platform – the need for change is clear, but finding the resources and energy to deliver that change while simultaneously providing safe patient care can seem almost 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 making practical changes to the way that care is delivered can benefit patients. In this report, we have highlighted good practice so that others can learn from it, be inspired by it and adapt what is relevant to use in their own improvement journey. Moving away from an insular approach and actively sharing learning between organisations will be increasingly vital if the whole system is to move forward together."
CQC's analysis shows variation both in the quality of care between hospitals and between individual core services within the same hospital. While the majority of hospital services are delivering good quality care and looking after patients well, inspections have also uncovered pockets of poor care even in good hospitals.
Across all acute trusts, critical care services and services for children and young people have received the most ratings of good and outstanding (66% and 68% respectively). Of all the core services CQC rates, urgent and emergency services have received the highest number of inadequate ratings (9%) followed by medical care (5%).
This reflects the fact that many Accident and Emergency departments are struggling to cope with ever increasing attendances.
Despite the well-documented challenges that the NHS faces, CQC has found much good and outstanding care and has awarded 'outstanding' ratings to five acute NHS trusts and five acute specialist NHS trusts. Also, 15 acute NHS trusts have exited special measures since July 2013 and have delivered innovative changes in order to do so.
Industry reaction:
Prof Jane Dacre, president of the Royal College of Physicians, said: “The CQC’s report is yet more evidence that the NHS is struggling to meet rising demand.
“Demand has been increasing by 4% a year, but funding has failed to keep pace. Indeed, 85% of hospital doctors have told us that current funding is insufficient to meet demand. We have heard repeatedly from our members that there are not enough doctors and that gaps in rotas are becoming increasingly widespread. Doctors have also told us that this is putting patients at risk. In our recent report, Against all odds, the RCP set out the scale of the challenge and the level of demand that is being placed on the NHS now and over the recent winter months.
“While physicians are doing their best to deliver safe and effective care for patients under increasingly difficult circumstances, urgent action is needed to ensure that services are properly resourced to meet the demands that are placed upon them and that staff are supported to deliver the excellent care that patients deserve.”
Dr Jennifer Dixon, chief executive of the Health Foundation, said: “If there is one organisation in England that has the clearest picture of the quality of care in hospitals, it is the CQC.
“The stark warning from the chief inspector of hospitals is this: economic pressures are putting patients at risk, with 60% of hospitals are in the red. Under the financial squeeze the CQC reports that current pressures on hospitals are acute, with the brunt being felt in urgent and emergency services and care for older people.
“In December one third of trusts issued alerts indicating urgent action was needed to cope with pressures from the volume of patients seeking emergency care. The number of people waiting more than four hours for a hospital bed is now more than five times the number recorded five years ago. Four out of five hospitals need to improve the safety of care.
“Yet there are positive signs despite the pressure. Staff are rated very highly for being caring and compassionate. The CQC has seen that transformation of services is possible in even the most challenging of circumstances. For many patients the length of time they spend in hospital is reducing as care becomes more efficient. The overt dedication of frontline staff to their patients leads the chief inspector to describe them as ‘heroes’. Almost 60% of services were rated as good or outstanding, with 5% rated as inadequate.
“The NHS is highly valued by the nation, used by everyone at some stage of their life. Next week’s budget presents government with the opportunity to ease the pressure on the NHS by first investing in social care. Without it pressures on emergency care will mount, and further transformation will slow if staff have capacity only to cope with immediate pressures.”
