Monthly column for providers and professionals working in healthcare from Professor Ted Baker, chief inspector of hospitals.

Demand on health and social care services is increasing year-on-year. This increased workload puts quality of care at risk but, despite these pressures, we have found that hospital trusts that put a focus on continuous quality improvement (QI) have demonstrated that they can deliver high-quality care.

In those trusts we have rated as outstanding, we have found a culture of quality improvement embedded throughout the organisation. When QI is used well, staff are engaged, they are focused on the quality of patient care, and they are confident in their ability to improve.

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Quality improvement in hospital trusts report cover

I encourage everyone to review our report, Quality improvement in hospital trusts, which shares learning from acute, community and mental health trusts. It highlights what trusts have told us about their experiences of using QI as a systematic approach to improving service quality, efficiency and morale. It is not a ‘how-to guide’, but rather, uses the words of hospital staff and case studies of successful initiatives to share learning with other trusts and inspire those who may be considering adopting a QI approach.

We know this is not easy — it’s a challenging task that involves changing behaviour in complex organisations, but it can be done and as this report shows, it can have a real impact on improving patient care.

Sexual safety on mental health wards report cover

This month we also published our report, Sexual Safety on Mental Health Wards, which calls for new national guidance to improve the sexual safety of people and staff on mental health wards, following analysis of how mental health trusts in England report sexual incidents.

The review was initiated following concerns from CQC inspectors about sexual safety on mental health wards. Those admitted to a mental health ward may include people vulnerable to sexual abuse and people who may lack the mental capacity to make informed decisions about sexual relationships. This, combined with a high number of detained patients on many mental health wards — some in old and unsuitable buildings — staff shortages and few staff trained in how to promote sexual safety, can put patients and staff at risk of harm.

The analysis of nearly 60,000 reports made between April and June 2017 found 1,120 sexual incidents involving patients, staff, visitors and others described in 919 reports — some of which included multiple incidents. More than a third of the incidents (457) could be categorised as sexual assault or sexual harassment of patients or staff.

We are working with partners to highlight this issue and make recommendations to improve sexual safety on mental health wards. Patients and staff must feel confident that any concerns will be followed up quickly and effectively and the appropriate action taken.

We are recommending new national guidance co-produced with people who use services, a strengthening of the reporting system so that it better reflects the impact of sexual incidents, and training to equip staff with the skills and knowledge to fully assess patient risk to help prevent incidents.

Continuing on the theme of patient care and safety…

You may have seen some recent media coverage raising criticism of the language used in our inspection reports with regards to maternity services. This criticism centred around claims that in some of our reports, the CQC appears to prioritise the ‘normality’ agenda in maternity care and praise trusts for low numbers of caesarean births. This was not our intention.

When we inspect maternity services, our judgements are based on whether women get safe care within an environment where they are supported to make informed choices about that care. Avoiding unnecessary intervention in any pregnancy, particularly low risk pregnancies, is important, but this should never be at the expense of a woman’s or baby’s health. It is vital that the approach taken is safe and informed by robust risk assessments with appropriate escalation pathways in place in accordance with the woman’s wishes.

Where we find caesarean section rates are an outlier above or below the national average, we will raise this with trusts and seek assurances that the appropriate safe pathways are available to all women who may wish a vaginal birth or who may wish or require a caesarean section — but it is not our view that trusts should be encouraged to reduce caesarean rates. It is about making sure the care provided is safe, personalised and appropriate. I hope this clarifies our position.

Finally, subscribe to get an alert when the new edition of our State of Care report publishes next month. This is our annual assessment of health and social care in England.

We make sure health and social care services provide people with safe, effective, compassionate, high-quality care and we encourage care services to improve.

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