HSJ Live 16.10.2014: CQC publishes state of care report

4.08pm Here’s Sarah Calkin’s story on the state of care report:

In its fifth annual state of care report the regulator called on the “wider system” to be more decisive in dealing with poor services and provide more leadership support.

The report said: “To date, the response to failure has been patchy.

“In some cases there has been denial of an uncomfortable truth, and in others there has been a lack of clarity over which organisation is taking responsibility to act swiftly in the interests of people who use services.”

3.40pm Commenting on the state of care report, Rob Webster, chief executive of the NHS Confederation, said:

“We know you cannot inspect quality into services. Quality and value is the primary responsibility of boards, NHS leaders, staff and teams. Inspection by external teams, including individuals with expertise gained as both professionals and patients, is a valuable contributor to managing and improving NHS performance and a good source of reflection and insight.

“From our ‘decisions of value’ report we know the importance of having the right relationships, behaviours and environment to deliver better value of care in the NHS and we welcome the emphasis CQC has placed on the value of strong leadership.”

3.29pm The Foundation Trust Network has also commented on the report. Head of policy Miriam Deakin said:

“At a time of constrained funding, rising demand, and changing patient needs, we are encouraged by CQC’s recognition of some excellent care by frontline staff in all sectors. The report also helpfully acknowledges the unprecedented financial pressures on providers which is compounded as they try to balance the costs of delivering immediate high quality care and investing in transformation of services. Adequate resourcing of the NHS is essential in order for providers to address CQC’s fair and strong emphasis on the need to reduce unacceptable variation of care across the NHS. There is a direct link between funding and performance - you get what you pay for - and NHS finances must keep pace with demand growth and inflation.

“The role of CQC in providing robust and transparent judgements about the quality of care is absolutely fundamental to enhancing public confidence in the NHS and maintaining credibility among those regulated. NHS providers recognise this and have supported CQC’s work during the past year to help develop the new inspection regime and drive improvements for patients in their local areas. Nonetheless, our members tell us there is more for the CQC to do to ensure consistency and robustness of judgement and the calibre of its inspection teams.

“Our members place quality of care at the heart of everything they do as they strive to meet the high standards of care that each person has a right to expect. Inadequate care will never be acceptable and there is more for the NHS to do. This report presents a useful picture of the NHS’ achievements alongside the remaining challenges. This is important to build and maintain the public’s confidence in its health service.”

3.10pm Some reaction to the state of care report, firstly from the Nuffield Trust’s Nigel Edwards:

“The report highlights problems of variation and poor quality in health and social care, and that good leadership will be crucial in sorting this out. But we are concerned that it is becoming increasingly difficult to recruit the best people to executive and director roles in many NHS organisations.

“The pressure to continue to improve standards is leading to a growth in nursing numbers and agency staff in hospitals. This is causing significant financial problems for the NHS in the coming year and drawing much-needed resources away from other areas like mental health or GP services, putting at risk the ability to deliver an acceptable quality of care in the long run.

“The annual statement from our QualityWatch programme with the Health Foundation published last week found signs that growing pressures on health and social care are starting to push the big quality improvements of the past decade into reverse. The CQC report echoes our concerns about the quality of mental health care, in particular about the pressure on inpatient beds leading to patients being admitted a long way from home.

“The results of the CQC’s inspections reveal particularly striking differences in care quality within hospitals. As we argued in our review of hospital ratings, conducted for the secretary of state in 2012, providing a single overall rating for hospitals is difficult when different departments within the hospital can offer care to varying standards.”

2.37pm The CQC has published its annual state of care report. The regulator says variation in the quality and safety of care in England is too wide and is unacceptable.

CQC’s chief executive, David Behan said: ‘The findings from our inspections over the last year clearly show there is too much variation in quality and safety between services and within services. People need to have confidence that they will get good care. Our role is to identify what works well and why, and what doesn’t work, and use this information to drive improvement and close the gap.

‘Our inspections have also found variation within services. For example, while most hospitals are rated at least good for the way they care for people, the majority require improvement when it comes to keeping people safe.

‘We acknowledge the rising pressure on care services. Financial pressures are real but not unexpected, and yet we continue to see many examples of good and outstanding care even in financially challenged organisations. 

‘From our inspections, the safety of services is our biggest concern. Care providers must make the basics of safe care a priority and build a culture of safety in their organisations, learning from the best. The principle of keeping people safe from harm is fundamental. Strong, effective leadership at all levels in an organisation is vital. Our new inspections of NHS trusts have found that good leadership drives up quality and safety overall.’

2.23pm Booking a GP appointment is just as difficult as snaring sought after concert tickets, MPs were told, as Labour warned the NHS is at “breaking point”.

Shadow health secretary Andy Burnham renewed his attack on the government’s handling of the NHS, an area Labour wants to become a key election battleground, by hitting out at the “deterioration” of waiting times - particularly in A&E and cancer patients.

1.30pm The chief inspector of hospitals has urged trusts to encourage their top clinicians to lead Care Quality Commission inspections.

Sir Mike Richards issued the call during an HSJ webinar last week, in response to concerns about the quality of inspection teams.

“You ought to be releasing to us the same number of those clinical experts as you expect to come on your inspection,” he said.

12.36pm Also in The Telegraph; more than 300 terminally ill people in England a year could be taking their own lives because there is no possibility of assisted suicide, according to a study by campaign group Dignity in Dying.

The charity’s chief executive Sarah Wootton, said: “The findings in the report show why it is imperative that we no longer turn a blind eye to people’s suffering at the end of life.

“Politicians need to act now and give dying people the option, and the peace of mind, to know they can control the manner and timing of their death.

“The current law does not protect patients, healthcare professionals or family members.

“Terminally ill people are taking their own lives, often in secret and without support, with the potential of causing even more distress for themselves and their loved ones.”

12.01pm Telegraph columnist Tom Chivers considers whether measures such as smoking bans and alcohol taxes really reduce the harms caused by tobacco and alcohol. This comes amid the latest move to ban smoking in public parks, as recommended by the London Health Commission report.

He concludes: “ There are profound questions of personal liberty involved, about how far should adults be able to harm themselves (and those around them).

“But on their own terms, these “nanny state” measures do seem to be effective.”

11.23am In The Daily Telegraph, Boris Johnson has criticised proposals to ban smoking in London parks as “bossy and nannying”, while the government confirmed it had no plans to implement the measure across the UK.

The recommendation was came as part of the London Health Commission report, published yesterday, authored by former health minister Ara Darzi. Lord Darzi was appointed by the Mayor of London to chair the Commission.

Commentator Alan Massie has criticised London Health Commission’s proposal to ban smoking in parks in a comment piece for The Telegraph.

“It seems highly unlikely that the sight of an old buffer like me smoking a Toscano cigar while resting on a park bench is going to appear an attractive role model to a young person,” he argues.

“Smokers have accepted the existing ban, however reluctantly. We accept that it has made other people’s life more agreeable, even though we continue to believe that the reasonable compromise of designated smoking rooms in pubs, clubs and restaurants should have been acceptable.

“But there is no justification for the London Health Commission’s new proposal: it is malicious. Boris Johnson should bin it.”

10.57am The Guardian reports that hospitals are wasting up to £2.5bn a year of the NHS’s budget through poor care and medical errors, such as giving patients the wrong drug, the health secretary, Jeremy Hunt, will claim today.

Hunt will renew his criticism of inadequate patient safety standards in the NHS by warning of a “dangerous nexus between poor care and higher cost”.

10.06am The Financial Times reports the prime minister is to be given the final choice on the appointment of the most senior civil servants, in a move that risks fuelling charges of Whitehall politicisation.

The rule change, which comes into force in December, concludes a three year struggle between the government and top civil servants over how big a role ministers should play in selecting about 25 senior posts.

10.00am The Times reports that patients face more rationing of treatments on the government’s Cancer Drugs Fund, as health chiefs said the present system was not working and undervalued the lives of patients with less high-profile diseases.

NHS England said many medicines available through the fund would “go down in flames” as they begin a tougher assessment process designed to stop paying for the least effective treatments.

The National Institute for Health and Care Excellence said it wanted closer control over the fund.

9.56am A ‘special measures’ regime could be introduced for clinical commissioning groups with severe problems under plans being considered by NHS England, HSJ can reveal.

The adoption of the term, brought in last year for the most challenged NHS providers, is under consideration as part of an overhaul of the CCG assurance regime.

Its use is seen as a way to acknowledge that some CCGs also have major performance, finance or quality problems, and to create greater impetus for them to improve.

7.00am Good morning and welcome to HSJ Live.

GPs occupy just a quarter of accountable officer posts in clinical commissioning groups, a comprehensive survey by HSJ has revealed.