Monthly column for providers and professionals working in healthcare from Professor Ted Baker, Chief Inspector of Hospitals
As you will no doubt have seen, this month saw the publication of State of care 2018/19. The headline findings, including why this report focuses particularly on inpatient mental health and learning disability services, are covered in this blog from Care Quality Commission chief executive, Ian Trenholm. What I’d like to talk about this month are some of the findings across the NHS and independent health.
Despite continued pressures being experienced by all services, I am pleased to see that most services are maintaining — and in many cases improving — their ratings. This is a testament to the hard work from everyone, and achieving that success is no mean feat. We are also pleased to see progress in collaborative working. While integration isn’t happening everywhere, and we acknowledge that different areas will be working at different speeds, we have seen more services beginning to provide more joined-up care. The move to integrated care supports the ambitions of the NHS Long Term Plan, and — crucially — means that people can receive high quality care that meets their different needs.
However, safety does remain a concern — particularly in NHS acute, mental health and independent health services. We are also seeing continued challenges with recruitment and retention, which can exacerbate other staffing challenges, leading to more pressured work environments and staff leaving the service, further contributing to staff shortages. We all know that having the right staff, in the right place, at the right time is crucial to delivering good care, which is why we are calling for system-wide action on workforce planning which encourages more flexible and collaborative approaches to staff skills and career paths.
As ever, we also shine a light on some of the good practice that we have seen and have a number of case studies throughout the report which I hope you will find interesting and inspiring.
If you haven’t done so already, I would encourage you to read State of care, reflect on its findings and consider what they might mean for you, your colleagues and your service.
Hot on the heels of State of care, we published the findings of our urgent and emergency care survey.
This is part of our national survey programme and sought the views of 50,000 people who received urgent and emergency care from services provided by 132 NHS trusts across England. We specifically heard from patients who attended either a major consultant-led A&E department (Type 1) or an urgent care or minor injury unit (Type 3) run directly by an acute hospital trust during September 2018.
I was pleased to see that most people surveyed reported positively about their experience. As with the improvement we highlighted in State of care, this is despite continued pressures and is down to the dedication and hard work of hospital staff across the country.
The results do suggest there is scope for improvement in several areas across both service types, however. These include: waiting times; information provision when leaving hospital; and help form staff with pain control. Less positive responses in these areas point to the impact of increased demand and pressures on staff who are at full stretch.
I would like trusts to reflect on their survey results to understand what their patients really think and help identify what changes they can make to drive improvements.
I want to bring your attention to a letter we have written to independent cosmetic surgery providers.
We have inspected 65 services that provide solely cosmetic surgery and/or hair transplant surgery, representing just under two thirds of those currently registered.
While we have seen some good individual practice, these inspections have also found some common areas of concerns. These include issues around staff training, qualifications and competencies; unsafe practice in the use of sedation and anaesthetics; variable standards of governance and risk management; and concerns around equipment maintenance.
My letter to these providers highlights these emerging concerns and clarifies the standards of patient care that we as the regulator expect, and that patients deserve.
The letter is available in full on our website. We also have a guide for people who are considering any kind of cosmetic surgery with tips to help them make sure they will receive safe, compassionate and high-quality care.
Finally, you may remember that last winter we carried out some focused inspections of emergency departments where our intelligence suggested an increased risk to patient safety. These were in line with our methodology and focused specifically on the five key pressure points that we know from our engagement with frontline staff can impact on their resilience at times of peak demand; assessment and triage, management of deteriorating patients, patient flow through the department, workforce, and leadership and culture.
We gave immediate feedback to trusts following these inspections and aimed to publish our full findings in a shorter timeframe to support trusts by identifying changes they could implement and benefit from quickly. We plan to take a similar approach this winter and will be talking about this more in due course.
In the meantime, you may find it beneficial to revisit our reports: Sharing best practice from clinical leaders in emergency departments and Under pressure: safely managing increased demand in emergency departments which include examples of actions some trusts have taken to help plan for and manage increased urgent and emergency attendances.