Commissioners and regulators need to improve their ‘patchy’ record of supporting struggling providers, the Care Quality Commission has said.

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.”

David Behan

Strong leadership at all levels is vital, says David Behan

It called for “tough decisions about changing ownership, changing board members, or decommissioning services” to be taken quickly and more attention on “supporting failing providers to upskill or bring in strong, effective leaders”.

The report, a round up of findings from inspection activity over the past year, found the safety and leadership of services were the areas requiring the most improvement. Good leadership was essential to set a culture that prioritised safe care.

It found the CQC’s ratings of an organisation’s leadership had a stronger correlation with its overall judgement of an provider than any of the other four domains its inspectors look at.

In almost 90 per cent of the 62 new style acute trust inspections, the overall rating matched the well led rating, compared with 56 per cent for caring; 74 per cent for effectiveness; and 78 per cent for both responsiveness and safety.

CQC chief executive David Behan said: “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.”

The report also provides an insight into the themes emerging from the first inspections of mental health and community providers.

At the 12 mental health trusts visited by the end of August it said inspectors commonly found poor estates, a failure to comply with same sex accommodation requirements, and widespread bed shortages.

In the community sector, where eight standalone community trusts have been inspected so far, inspectors found staff shortages and inconsistent training of staff in risk management and incident reporting.

The report acknowledged the “mounting financial challenge” faced by health and social care providers. However, it said this was not an excuse for inadequate care and claimed variation in quality exists between providers with the same level of resource and challenge.

Miriam Deakin, head of policy at the Foundation Trust Network, welcomed the CQC’s recognition that there were still many examples of excellent care in the NHS, despite the financial constraint.

She said: “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.”

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