In its fourth report to Parliament, the Care Quality Commission sets out its findings based on more than 35,000 inspections carried out by its inspectors during 2012/2013.
The CQC has made several changes in the way it works, starting with the appointment of Chief Inspectors of Hospitals, Adult Social Care and General Practice who will be leading specialist inspection teams which will include clinical and other experts, as well as people with experience of care. The inspections of acute hospitals in September 2013 were the first to use the new model.
Its findings in 2012/13, across the care sectors that it regulates, would indicate that in some 90 per cent of cases, people were treated with dignity and received the necessary care, treatment and support to keep them safe and meet their needs. The failures documented by the inspectors were not trivial. In around half of the cases across all sectors, examples of poor care were found to have a major or ‘moderate’ impact on people.
More than 9 per cent of people, aged 75 and over, experienced at least one emergency hospital admission for a potentially avoidable condition. The report states that the effect of hospital admission on vulnerable – particularly older – people, is serious. It undermines their self-confidence, increases their dependency and risks further threats to their health and wellbeing.
The CQC looked at the numbers of older people who had to go to hospital in an emergency for conditions that it was thought were generally avoidable by virtue of the fact that they should have been managed, treated or prevented within the community. It was felt that these conditions were often the result of poor care or neglect. The conditions included diabetes, bone fractures, pneumonia and urinary infections.
“Even if people are well cared for when they reach hospital, the fact that they have had to go there in the first place could point to poor overall care. This may be the result of many factors, but high among them is the interaction between primary health care (GP services), secondary health care (hospitals) and social care (care homes and care provided in people’s own homes).”
“Now that we regulate GP practices as well as other care settings, we intend to explore in future reports how GP practices, social care services, hospitals and community health care all work together to reduce the need for people to go into hospital unnecessarily.”
The percentage of people in England living with a long term condition/s that limit/s their daily activity has changed little over 10 years at 18 per cent. In the community, more than 10 per cent of social care inspections uncovered examples of poor care. One in five nursing homes revealed safety concerns and ongoing staffing pressures. in residential homes and more than 10 per cent uncovered problems with safeguarding, staffing, care and support received by residents. A link was found between numbers of deaths and higher staff turnover rates.
Similarly, in home care services, problems were found with staffing and quality monitoring.
The problems in NHS hospitals (10 per cent) related to poor assessment and monitoring of the quality of care that they provided. In these cases, there had been no improvement in safety and safeguarding, or in treating people with dignity and respect.
Of particular concern is the number of people in hospital who have dementia continuing to have poorer outcomes.
In addition to social care and NHS services, the report covers independent health care and primary dental care. It includes interesting demographics on older people, the conditions affecting them and the unpaid care sector, as well as GP provision.