As the regulator of health and social care in England, the Care Quality Commission (CQC) plays a vital role in making sure people get safe, high-quality and compassionate care and in supporting providers to improve.
Between 2014 and 2017 CQC’s comprehensive inspection programme provided a robust baseline understanding of quality across health and social care. Over the past year we have used that baseline understanding to strengthen how we monitor, inspect and rate services and adapt our next phase approach to be more intelligence-driven, targeting inspections where we see that the quality of care has changed.
Our inspection and monitoring of England’s hospitals to date has shown that the majority of people are receiving safe, good quality care – with 62 per cent of hospital services rated as “good” and seven per cent rated as “outstanding”. We’ve also seen a number of hospitals improve their rating as a result of the progress we identified when we reinspected.
However, there remains variation in the quality of care between hospitals and in some cases between services in the same hospital. This reflects the scale of the challenge that hospital trusts and other providers are facing as the number of patients with increasingly complex conditions continues to rise, placing more pressure on all health and care services.
The impact of this rising demand is often intensified during the winter months where we typically see an increase in the number of people attending emergency departments, often with more complex needs requiring more medical attention. However, it is no longer just in winter that emergency departments experience such pressures. In our recent report “Under pressure: safely managing increased demand in emergency departments”, we looked at the findings from the CQC’s inspections of urgent and emergency services and the key challenges that emergency department staff told us they faced. Our inspections have shown that more needs to be done to ensure patients receive consistently safe care.
The report highlighted practical solutions from those frontline staff that can be used to help maintain safe services and called for wider action by the whole health and care system to ensure a joint approach to managing the capacity problem as demand continues to grow.
The need for a whole system approach was also a finding from the local system reviews which CQC carried out during 2017/18. These reviews explored how well health and social care systems in 20 local areas were working together to support and care for older people moving between health and adult social care services. Sadly, we saw some poor practice where a lack of co-ordination and co-operation between services badly affected older people’s experiences. But we also saw that positive outcomes for people can be achieved when leaders in local health and care organisations work well together and support their staff in providing person-centred coordinated care.
As pressures and demand continue to rise, the only way to ensure good, safe, sustainable care is for all parts of the health and care system to collaborate to provide a coordinated patient journey. But, to do this, we need new approaches to funding, commissioning, performance measurement and regulation that encourage local systems to collaborate more effectively to deliver personalised care to the people who rely on their services, and to safeguard quality of care into the future.