This week the Care Quality Commission (CQC) have published their annual report on the state of care. It provides a useful overview of the state of care services in England, and also tells us a little of the state of the regulator too.
Everyone understands that these are difficult times for care services. The financial constraints introduced in 2010/11 are starting to bite and the NHS is still coming to terms with its recent re-organisation. Many people are worried about the impact this may be having on the quality of care delivered.
England’s regulator of care quality is able to offer a unique insight on the state of care by compiling the results of the 35,000 inspections they perform each year. In some respects their findings can be seen as reassuring in that they did not show radical decline.
Levels of compliance with CQC’s standards had not deteriorated, and in most cases improved slightly. They saw similar results in NHS, independent and adult social care sectors.
There are still many aspects of care services for which routinely available information on quality is inadequate or non-existent
Is that good? Well, the CQC would be quick to point out that they estimate around one in ten care services do not provide the quality of care that users have the right to expect. They also identified a possible trend that the nature of the failures identified during inspection tended to be more serious than in earlier years.
However, the fact that they did not observe any reduction in compliance over time implies that the service is holding up, at least as of April 2013.
Some of the CQC’s observations echo the initial findings from QualityWatch, our joint programme of work with the Health Foundation. Our first Annual Statement reported that waiting times generally remain low, improvements in safety have been maintained and a number of indicators show improvements in effectiveness.
However, there are still some concerning areas. The CQC’s report highlights an increase in the number of older people needing emergency admission to hospital for conditions that are generally avoidable, and worse outcomes for patients with dementia.
QualityWatch noted persistent problems with person-centred care and signs of stress in urgent care services.
Everyone also understands that these are difficult times for the regulator. The past few years have seen the performance of the regulator in the spotlight more than before. In the last 12 months it has faced ferocious criticism, replaced its entire top team and often found itself the focus of stories that started with instances of poor care.
In response to the Francis Inquiry the Government asked the CQC to host three new chief inspector posts, which has led to wholesale change in the organisation’s inspection methods.
The first of the new models to emerge has been the hospitals inspection programme, which has attracted favourable comparisons to the clinical governance reviews of the early 2000s and appears to be a more in-depth process than the previous methodology.
Their challenge will be to apply it across the board (and with a high level of robustness) within the limits of the resources they have available. The return of service ratings also marks another significant change in the way the CQC will be assessing the state of care in 2014.
While the ability of programmes, such as QualityWatch, to measure and assess quality of care using data is improving, there are still many aspects of care services for which routinely available information on quality is inadequate or non-existent.
Even where data are available, experience tells us that it is not always easy to predict indicators of system failure (as last week’s news about Colchester attests).
Failures in the quality of care can manifest in so many different ways that it is important that we continue watching services across the board. Physical inspection remains a vital part of providing independent assurance of the quality of care services.
In both cases – the quality of care services and CQC’s new inspection programme – there are no simple solutions. No one really knows yet what the impact of the recent changes will be, and it is important not to cast judgement too early. We must keep watching.
Blunt I (2013) ‘The quality of care: we must keep watching’. Nuffield Trust comment, 21 November 2013. https://www.nuffieldtrust.org.uk/news-item/the-quality-of-care-we-must-keep-watching