Care Quality Commission
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CQC publishes first full analysis of performance and risk in health and social care

Yesterday, the Care Quality Commission publishes a comprehensive ‘snapshot’ of the performance of health and social care providers in England, based on unannounced inspections of over 14,000 locations

The report shows how the NHS, independent hospitals, social care and dental providers are performing against the essential standards of quality and safety required by law. It also takes a closer look at NHS maternity services, as an area coming under increasing pressure.

The ‘snapshot’ of performance as at 31 March 2012 shows the majority of providers across all sectors were meeting the essential standards of quality and safety - 72% in adult social care, 77% in NHS services and 82% in independent healthcare. Where services were not meeting essential standards, CQC has taken action – ranging from improvement plans to restriction or closure of services in extreme cases.

Themes in poor performance have been identified - both what the analysis of inspection data tells us, and what CQC inspectors believe are the areas of emerging risk.  The key problem areas common to both NHS and social care are:

  • Management of medicines (17% of all locations inspected failed to meet this essential standard) Our inspectors are seeing a worrying number of examples where the risks associated with medicines are not being properly managed - often due to a lack of information given either to those taking the medicines, or those caring for them.  We are also starting to see more complex drug treatments and significant growth in co-morbidity, putting an increasing demand on social care environments in particular.
  • Staffing (11% of all locations inspected failed to meet one or both of the two standards related to staffing). Issues around staffing emerge as a key driving factor in many instances of non-compliance, both in terms of the numbers of staff available and in the support they are given to do their job. The non-availability of temporary staff and organisations leaving vacancies open for a number of months – particularly for qualified staff – can lead to compromises in the quality of care given to people, and staff training and supervision.
  • Record keeping (15% of all locations inspected failed to meet this standard.) Issues range from records – which include crucial information about people’s care - being incomplete or not up-to-date; not kept securely or confidentially; or not showing that risks to people had been identified and were being managed.

These are all issues that have an impact on the fourth essential standard that had the poorest performance across the board – care and welfare of people and patients.

The safety and suitability of premises was also an issue of increasing concern to inspectors, particularly in social care.  Amanda Sherlock, Director of Operations, commented:

"Over the last year, inspectors have noticed deterioration in the physical state of some of the care homes they inspect. Often it’s just cosmetic, but occasionally it’s things that actually present a risk to people’s safety. While difficult to evidence, it’s likely that increasing failure to address these kind of problems is linked to increasing economic pressure within the system.” 

The report includes a special focus on maternity services, emerging as a problem area for a number of NHS Trusts due to midwife numbers not increasing in line with demand and an increase in complex births - owing to risk factors including maternal age, weight and co-morbidity. CQC looked at the information we hold on maternity services in conjunction with analysis of data from other sources, and have highlighted significant regional disparities.

CQC will use subsequent quarterly reports to monitor areas of emerging risk and use the information to inform our inspection activity – as well as sharing it with other bodies that have responsibility for ensuring that people are protected from poor care.

This report, based on the largest number of unannounced inspections conducted under any previous regulatory regime, is the first stage of a process by which CQC will move its information reporting towards a model that is able to provide more insight into the systemic reasons for poor performance.  

Commenting on the report, CQC’s Deputy Chief Executive Jill Finney said:

“The data that CQC holds on performance across health and social care is unique in breadth and scale.  In our first market report, we use this data to look at patterns of performance across sectors, at the specific areas where providers are failing to meet people’s needs – and we describe the action we’ve taken to hold providers to account for these failings.  

“We’ve also asked inspectors – our ‘eyes and ears’ on the ground - if there are other emerging trends that are not yet apparent in terms of numbers, but are causing them concern. This adds another dimension to our assessment of risk and where we need to focus our attention – we hope this intelligence will also be useful to other parts of the health and social care system.

“Now that we’ve collected a significant amount of inspection data, we can use this information to probe more deeply into what lies behind risks in the system – this report is the first step in that process.

“CQC will use this information to help target our unannounced inspections – but we also want providers to look closely at this report in order to assure themselves that they are taking all steps necessary to protect people from poor care.”

For further information please contact the CQC press office on 0207 448 9401 or out of hours on 07917 232 143.

About the Care Quality Commission

The Care Quality Commission (CQC) is the independent regulator of health and social care in England. We make sure that care in hospitals, dental practices, ambulances, care homes, people’s own homes and elsewhere meets government standards of quality and safety – the standards anyone should expect whenever or wherever they receive care. We also protect the interests of vulnerable people, including those whose rights are restricted under the Mental Health Act.

We register services if they meet government standards, we make unannounced inspections of services – both on a regular basis and in response to concerns – and we carry out investigations into why care fails to improve. We continually monitor information from our inspections, from information we collect nationally and locally, and from the public, local groups, care workers and whistleblowers. We put the views, experiences, health and wellbeing of people who use services at the centre of our work and we have a range of powers we can use to take action if people are getting poor care.

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