The Care Quality Commission has published its third annual report to Parliament on the state of health and adult social care in England.
The report covers the period April 2010 until March 2011 and encompasses evidence from the CQC’s first year of regulation under the Health and Social Care Act 2008.
CQC's chair, Dame Jo Williams, said: “This is the first time that all health and social care providers have been registered with us under the new Act. While it will be a further year before we can present a complete picture of the state of regulated care in England, this year’s report provides a valuable picture of people’s experiences of access to care services, the choice and control that they have when using services, and the quality of the care that is provided.”
Turning to the future, Williams said: “The next few years will see a changing landscape in care, but we are committed to maintaining a relentless focus on compliance with essential standards of safety and quality based on more inspections and providing timely information to the public. We will respond quickly to protect people where we find poor care, using our enforcement powers under the new legislation when we need to do so."
She added: "We hope providers and commissioners of services will use this information to improve care for the people using their services."
The report's main conclusions are:
Access to care and services
- Department of Health figures show that, following a long period of stability, there was a slight deterioration in the first few months of 2011 in waiting times for patients admitted to NHS hospitals. For patients who did not need to be admitted, waiting times remained steady.
- The 2010 NHS inpatient survey showed the proportion of inpatients saying that they were admitted "as soon as they thought was necessary" has been more or less the same for the past three years at around 75%. There was no change in the number of people given choice over planned admission dates, with nearly three quarters saying they were not given a choice.
- Social care has seen a continued rise in demand for services. In the last year the number of new contacts to councils responsible for providing social care rose by 4% to 2.12 million. Of these, just over half (52%) resulted in a further assessment or commissioning of ongoing service.
- Where the waiting time between first contact and completed assessment was known, 35% were assessed within two days, and 62% within two weeks, a slight improvement from the previous year. Five per cent overall had to wait more than three months for their assessment, the same as in the previous year.
- Evidence appears to show that the reduction in social care budgets and increased demand is resulting in local authorities tightening their eligibility criteria for people to receive state-funded community care.
Choice and control
- The Care Quality Commission began carrying out reviews of compliance by NHS trusts in April 2010, and of independent healthcare and adult social care providers in October 2010. Outcomes 1 and 2 relate to respecting and involving people who use services and consent to care and treatment. Our early findings suggest that independent hospitals and clinics, and domiciliary care agencies, had a higher level of compliance with these outcomes.
- Thirty-two per cent of NHS patients with a planned admission surveyed said they had been given a choice of hospital for their first appointment, 58% hadn’t but didn’t mind and 10% said they were not offered a choice, but would have liked one.
- The NHS survey showed no change over the last year in people’s access to information or involvement in decisions. Slightly over half (52%) of inpatients felt that they were "definitely" involved as much as they wanted to be; 37% said they were involved "to some extent", and 11% said that they were not involved as much as they wanted to be.
- The number of people able to exercise more choice over their social care by using a direct payment or personal budget has continued to increase. In 2009/10 13% of adults and carers receiving council funded social care had self directed support. The highest proportion was carers (24%), followed by adults aged 18-64 (15%) and then people aged 65 and over (10%). Local authorities’ expenditure on direct payments for adults rose by 31% in real terms to £815 million in 2009/10.
- In planning their services, NHS providers are more ready to take account of race and disability equality issues when compared with adult social care services. It is possible that NHS organisations, being larger, have greater capacity to undertake equality development work.
Quality and safety
- For both NHS and adult social care providers, failure to meet the regulations on Outcome 4 (‘effective, safe and appropriate care’). was one of the three outcomes with the greatest level of non compliance..
- On safety and suitability of premises (Outcome 10), care homes had the lowest proportions of compliance, and also the highest proportions of major concerns.
- One in five NHS trusts that we inspected under our Dignity and Nutrition programme were not compliant with at least one of the standards. We inspected 100 NHS hospitals unannounced to check whether older people were being treated with dignity and respect (Outcome 1), and whether they were getting food and drink that met their needs (Outcome 5). We saw many examples of excellent care, finding that 45 hospitals were meeting both of these standards. At 35 hospitals we made suggestions for improvement, although essential standards were being met. However, we found 11 hospitals that were not meeting one of the essential standards, and in nine cases neither of the two essential standards was met.
- The reporting of patient safety incidents or near misses is an important way in which organisations can learn from mistakes and support ongoing improvement. In 2010/11 there were 1.25 million incidents reported to the National Patient Safety Agency, an increase on the 1.19 million reported in 2009/10, and continuing the year-on-year increase.
- All organisations registered with CQC must show that they can meet Outcome 8 on cleanliness and infection control. The NHS continues to make good progress in tackling MRSA and C. difficile. In 2010/11 there was a 22% reduction in MRSA cases compared to 2009/10, and a 15% reduction in C. difficile infections.
- The NHS inpatient survey provides valuable information about inpatients' perceptions of cleanliness:
- There have been year-on-year improvements in patients' perceptions of hospital cleanliness. In 2010, 66% of inpatients said their hospital room or ward was "very clean" up from 64% in 2009. Four per cent said their rooms or wards were "not very clean" or "not clean at all", the same as in 2009.
- In 2010 the proportion of patients reporting that, as far as they knew, doctors "always" washed their hands between touching patients rose to 78% (76% in 2009). Ninety six percent of patients had seen promotional information asking patients and visitors to wash their hands or use hand-wash gels.
- The 2011 survey of people who use community mental health services was completed by over 17,000 people aged 16 and over. O overall, 29% of respondents rated the care they had received as excellent, 30% as very good and 20% as good. The results were similar to those in 2010. The vast majority of participants said they were listened to and had trust in their health and social care workers. However, the findings show there is room for improvement, especially in involving people more in some aspects of their care.
The full report can be found here: www.cqc.org.uk/stateofcare