State of Care 2018/19
Ian Trenholm, Chief Executive of the Care Quality Commission introduces our annual report on the quality of health and social care in England
In this year’s State of Care 2018/19 report, we found that too many people can’t get access to the right care at the right time and that services are struggling to cope with increased demand.
Despite these challenges around demand, and the significant funding and workforce pressures felt by sectors, good quality care has largely been maintained. We should recognise the hard work of staff and volunteers who care for people across health and social care services.
I want to particularly highlight the providers who are working together in new ways that not only improve quality but are giving their teams more development opportunities and flexibility to work across different settings, supporting them to deliver great care.
However, whilst most care is good, too many people are unable to access good care when they need it. Some people are being pushed into wholly inappropriate care settings, such as emergency departments when they are not able to get the care they need locally.
Increased demand combined with challenges around workforce and access risk creating a perfect storm in mental health and learning disability services
In this year’s report I wanted to focus on mental health and learning disability services — this is the area where we are seeing a disturbing impact on quality, especially in hospitals, with a deterioration in ratings in inpatient mental health and learning disability services in 2018/19.
Increased demand combined with challenges around workforce and access risk creating a perfect storm, meaning people who need support from mental health, learning disability or autism services may receive poor care, have to wait until they are at crisis point to get the help they need; be detained in unsuitable services far from home; or unable to access care at all.
Difficulties in accessing the right care can mean that people with a learning disability or autism end up detained in unsuitable hospitals. CQC’s ongoing thematic review, which began in 2018, highlighted the prolonged use of segregation for people with severe and complex problems who should instead be receiving specialist care from staff with highly specialised skills.
Last week we wrote an open letter to providers asking them to ensure that their services and staff are fully aware of their duty to act where this is a risk that a person’s human rights are being breached.
We are also strengthening our approach to how we look at these services, and how we use the information that people share with us, so that we spot and act on poor care more quickly.
I look forward to working with NHS England on this important issue, following their plans announced last week to set up a new taskforce to improve current specialist children and young people’s inpatient mental health, autism and learning disability services in England. Their announcement that the taskforce will focus on boosting community services and reducing the over reliance on inpatient care is welcome.
Local areas need more and better integrated community services. In our report we highlight providers who are working together in new ways to deliver great care. They need to be supported by Parliament, commissioners, and national and local leaders to deliver change in how and where people are cared for and how they are helped to stay well.
Having the right staff to deliver good care is also crucial to making a difference to these services.
We found that in the majority of mental health inpatient services rated inadequate or requires improvement since October 2018, there was a lack of appropriately skilled staff. This reflects a national shortage of nurses in these areas of practice, with 8% fewer learning disability nurses registered with the NMC in 2019 than 2015.
This is why we are calling for national action on workforce planning which encourages flexible and collaborative approaches to staff skills and career paths, and why the Government’s ambitious plans to expand the mental health workforce to meet rising demand must be accelerated.
I would encourage you to read the report to find out more about issues such as the state of the workforce, the use of technology, access and collaboration across services in local areas, all of which combine to shape the quality of care for people in health and adult social care services across the country.
I am sure many of you will support the findings in the report. Let us know what you think by joining the conversation on Twitter using #StateOfCare.
