• CQC warns of care quality ‘fragility’, as some ‘good’ services see deterioration
  • Warns patient safety may be ‘compromised’ in future if providers don’t collaborate better
  • Social care remains one of the ‘greatest unresolved public policy issues’ and solution ‘urgently’ required

More than a quarter of mental health trusts and almost a fifth of acute trusts previously rated ‘good” have got worse on reinspection, the Care Quality Commission’s annual State of Care report reveals. 

The report warns that, although care quality had generally been “maintained” in what the CQC called the “toughest climate that most can remember”, there was deterioration in a significant number of providers.

Sir David Behan, the CQC’s chief executive, said: “What is different to last year is that there is some deterioration.

“Over the past 12 months when we have gone back to reinspect services that we have originally rated as ‘good’ we have seen a deterioration in the rating… It is this fragility around the quality of care that is leading to our view on the precariousness of future quality.”

This precariousness is linked to rising demand, because of increasing numbers of older people and people with complex long term conditions, says State of Care.

It shows more than a quarter of 49 mental health trusts originally rated “good” had seen their ratings cut on reinspection - 12 to “requires improvement” and one to “inadequate”. Several had deteriorated from requires improvement to “inadequate”.

For acute trusts, CQC inspectors have revisited 11 which were originally rated “good”. Two of these dropped to “requires improvement”. Of 64 originally rated “requires improvement”, eight dropped to “inadequate” when reinspected.

In contrast, 12 out of 15 acute hospitals initially rated as “inadequate” have improved on reinspection, and all nine mental health services rated “inadequate” improved.

Sir David warned that without better collaboration across providers, “we are going to see a fall in the quality of services that we are offering… and that may mean the safety of some people is compromised”.

Sir David also said the “future of the social care system is one of the greatest unresolved public policy issues of our time” and said a long term sustainable solution was “urgently required”. Recent reports suggest government is unlikely to provide one.

Nuffield Trust deputy director of policy Charlotte Paddison said the findings “speak broadly to the immense pressures on the healthcare system and how difficult they make it to sustain ‘good’ practice”. She said: “With resources so stretched it does make some sense to focus on those who are struggling, although commissioners and providers everywhere should stay alert to the risks of deterioration.”

The State of Care report also:

  • Said there has been a 2 per cent drop in registered nursing home beds between April 2015 and April 2017 – almost 4,000 beds.
  • Said that although the Royal College of Psychiatrists does “not recognise” locked mental health wards as “a service model”, almost three quarters of rehabilitation wards were offered in a locked ward. Two thirds of the locked wards were maintained by independent providers. Sir David said the government’s green paper due out this month on child and adolescent mental health services “presents a real opportunity for a step change in how mental health is delivered”.
  • Promises a greater focus in future on whether mental health services have an “active programme to reduce and minimise restrictive interventions” after concerns about the “very wide variation” in use of physical restraint.
  • Highlighted an almost 30 per cent point difference between the share of GP practices rated good (89 per cent) and out of hours and urgent care services (61 per cent). Similarly, 31 per cent of out of hours services are rated requires improvement compared to just 6 per cent of GP practices.