• Chief inspector warns of “extraordinary circumstances” for emergency departments this winter
  • Care model failure leaves hospitals overloaded
  • Watchdog warns of deterioration on mental health, learning disability and autism wards

A failure to provide the right models of care is forcing thousands more people to attend emergency departments each day, the Care Quality Commission has said, while warning of a “perfect storm” for the health service this winter.

The watchdog’s annual State of Care report, published today, sets out how the NHS’ failure to provide better care in the community, and to improve mental health services, meant over-stretched hospitals were facing “enormous pressures”.

This is being exacerbated by the government’s failure to provide a long-term funding and reform policy for adult social care, which left 1.4 million unable to access the care they need, it says.

The regulator warned of “extraordinary circumstances” facing emergency departments this winter. More than half (52 per cent) are now rated either “inadequate” or “requires improvement” by inspectors - an increase from 48 per cent in the previous year.

The CQC highlighted that July this year saw the largest percentage of patients waiting four hours or more in ED on record, alongside the largest number of attendances.

Chief inspector of hospitals Ted Baker said hospitals were facing “enormous pressure” and added: “Ten per cent plus extra work has been coming in [to A&E] over the last year, and the summer respite has not occurred this year. These are extraordinary circumstances.”

He praised staff efforts to maintain quality, but said: “We are asking even more of them this winter because they are starting from a higher baseline. There is a real concern about the pressure on acute hospitals and the knock-on consequences for waiting lists.

“This is not a solution that hospitals can manage. It’s not the A&E model that is broken, it is the system that does not provide the care in the appropriate place in the community, so people’s only access to care is through the ever open doors of A&E.

“That is the problem with the system we have at the moment; we are not providing the care that people really need so they have to access care that is not necessarily the best for them but is the only care that is available.”

Professor Baker said a combination of rising demand, workforce pressures and inappropriate care models had created “a perfect storm” across different types of services.

He particularly highlighted significant deteriorations in inpatient mental health, learning disability and autism services:

  • In the previous year, just 1 per cent of learning disability and autism wards were rated “inadequate” – this year that has leapt to 10 per cent. 
  • Seven per cent of children and young people’s mental health wards were rated “inadequate” following inspections compared to 3 per cent a year ago.
  • Eight per cent of acute mental health wards and psychiatric intensive care units were rated “inadequate” – up from 2 per cent.

These are very marked increases, while the balance of ratings for most sectors and services usually remain stable, and come amid a growing clamour of concern about these services. HSJ  revealed yesterday a CQC warning over staff oversight among independent sector providers of these services, which have seen more alerts over safety than NHS providers in recent years.

The CQC’s report today says 14 independent mental health hospitals have been rated “inadequate” since October 2018. It says workforce is a particular problem for these services, and highlights that the number of learning disability nurses registered with the Nursing and Midwifery Council has fallen 8 per cent since 2015.

The CQC also called for systemic action on workforce, specifically staff retention, as well as more service integration and innovation, and a long-term stable funding settlement for social care.

Other key findings in this year’s State of Care report include:

  • Almost two thirds of NHS acute hospitals are rated “good”, up 5 per cent on 2018. A total of 7 per cent are rated “outstanding”, up from 6 per cent in 2018;
  • 40 per cent of outpatients departments are rated “requires improvemen”t or “inadequate”;
  • 71 per cent of mental health trusts are rated “good” overall, compared with 70 per cent in 2018 – 10 per cent are “outstanding”, up from 8 per cent;
  • However, 3 per cent of mental health trusts are rated “inadequate”, compared to 1 per cent last year.


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