Monthly column for providers and professionals working in healthcare from Professor Ted Baker, Chief Inspector of Hospitals.

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This month has seen the publication of State of Care 2017/18, our annual assessment of health and social care in England. Each year, this flagship report looks at the trends, shares examples of good and outstanding care, and highlights where care needs to improve.

This year’s State of Care tells a story of contrasts, highlighting both the resilience and the potential vulnerability of a health and care system where most people receive good care. However, quality and access to care are not consistent and people’s overall experiences of care are varied.

The majority of NHS acute, community health and mental health services continue to provide good care, despite continued pressures rising demand and people needing services presenting with increasingly complex conditions. Most independent acute hospitals are also providing high-quality care for patients, but we found that independent acute services for children and young people need the most improvement — 37% were rated as requires improvement and 3% rated as inadequate.

Urgent and emergency care services remain an area of concern. Many are still struggling to make improvements, and as at July 2018, 7% of these services were rated as inadequate and 41% were rated as requires improvement overall. However, as the London Ambulance Service NHS Trust has shown, it is possible to improve in these challenging times. The organisation’s leadership was a key driving force in the trust moving from an initial rating of inadequate to a rating of good in the last inspection.

The safety of maternity care is also a key focus for us. Nearly half of all maternity and gynaecology services, and over a third of maternity services inspected under our new methodology needed to improve.

We recognise that increasing demand for services can make it harder to maintain the quality of care, however we have seen that it is possible to improve while managing system pressures. Earlier this year we shared case studies from NHS trusts and mental health trusts sharing the stories of providers that had achieved a significant improvement since a previous inspection.

Organisational culture is a key factor in driving the quality of care. The importance of having a focus on patients, openness, transparency and a culture where staff are encouraged to raise and report concerns, and feel empowered to make improvements cannot be understated.

Leaders are integral to setting the culture of an organisation. We know that capable, high-quality leaders create workplace cultures that are conducive to providing high-quality care. Our recent report, Sharing learning from trusts on a journey of QI, also demonstrated that leadership and an embedded quality improvement approach can improve service quality, efficiency and morale.

This is also a timely opportunity for me to remind you of our report published earlier this year which shares practical solutions for safely managing increased demand in emergency departments.

As part of our own approach to continuous improvement, we systematically review our inspection frameworks to make sure they’re up to date and reflect the latest guidance available.

We have recently made a number of updates to our core service and trust-wide well-led assessment frameworks.

The updates to the core service frameworks include the addition of guidance on eight high impact actions to improve the working environment for junior doctors; updated AMSAT prompts and the addition of the new National Dementia Action Alliance Dementia Charter.

The trust-wide well-led framework has been updated to reinforce the impact of research on the quality of care. This supports work we have been doing in collaboration with the National Institute of Health Research, the Health Research Authority, and the Medicines and Healthcare Products Regulatory Agency to recognise the role of research in delivering good patient care and encourage providers to consider it a part of their core business.

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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