Tag: Care Quality Commission

Community health and social care faces unprecedented pressures and financial uncertainty

In this Account Commission briefing about Scotland’s Integration Joint Boards (IJBs), we report that community health and social care faces rising unmet need and managing the crisis is taking priority over prevention due to the multiple pressures facing the bodies providing these services.

IJBs plan and commission many vital community-based health and care services.

People

One in 25 people in Scotland receive social care.

Expected to rise sharply due to an ageing population – 76% of people receiving health and social care are aged 65 and over.

By mid-2045, the number of people aged 65 and over is set to grow by nearly a third.

Performance

Where data is available, nationally there has been a general decline in performance of services and outcomes for people.

Data quality and availability is insufficient to fully assess the performance of IJBs and inform how to improve outcomes for people who use services with a lack of joined- up data sharing.

Care

Community health and social care faces unprecedented pressures and financial uncertainty. We have not seen significant evidence of the shift in the balance of care from hospitals to the community intended by the creation of IJBs.

Finances

IJB funding has decreased by £1.1 billion (nine per cent) in real terms to £11 billion in 2022/23. The funding gap is set to triple in 2023/24.

IJBs are making savings by not filling staff vacancies and using their financial reserves, but this is not sustainable.

Staffing

Vacancies are at a record high. Nearly half of services report vacancies. A quarter of staff leave jobs within their first three months. And there is continued turnover in senior leadership.

Action is needed now

IJBS need to share learning to identify and develop:

  • service redesign focused on early intervention and prevention.
  • approaches focused on improving the recruitment and retention of the workforce.
  • improvement to the data available.
  • commissioning approaches that improve outcomes for people.
  • ensure that their financial plans are up to date.

IJBs need to work together and with other stakeholders to:

  • ensure that the annual budgets and proposed savings are achievable and sustainable.
IJB-reportDownload

MEANWHILE, DOWN SOUTH …

ENGLAND’S SOCIAL CARE WATCHDOG ‘NOT FIT FOR PURPOSE

The Care Quality Commission (CQC), the body responsible for regulating adult social care services in England, is ‘not fit for purpose’, according to the health secretary Wes Streeting.

Health and Social Care Secretary Wes Streeting was responding to an independent review that identified ‘significant internal failings’ within the health and social care regulator.

The interim report, led by Dr Penny Dash, chair of the North West London Integrated Care Board, found the number of inspections being undertaken were well below pre-Covid levels.

It also revealed a lack of clinical expertise among inspectors, a lack of consistency in assessments and problems with the CQC’s IT system.

Commenting on her findings, Dr Dash said: ‘The contents of my interim report underscore the urgent need for comprehensive reform within the CQC.

‘By addressing these failings together, we can enhance the regulator’s ability to inspect and rate the safety and quality of health and social care services across England.’

Mr Streeting commented: ‘When I joined the department, it was already clear that the NHS was broken and the social care system in crisis.

‘But I have been stunned by the extent of the failings of the institution that is supposed to identify and act on failings. It’s clear to me the CQC is not fit for purpose.’ Kate Terroni, CQC’s interim chief executive, said the regulator accepts in full the findings and recommendations of the report.

‘Many of these align with areas we have prioritised as part of our work to restore trust with the public and providers by listening better, working together more collaboratively and being honest about what we’ve got wrong,’ she said.

‘We are working at pace and in consultation with our stakeholders to rebuild that trust and become the strong, credible, and effective regulator of health and care services that the public and providers need and deserve.’

The interim findings of the review of our operational effectiveness led by Dr Penelope Dash have been published this morning. In response, Kate Terroni, our interim chief executive, said: “We accept in full the findings and recommendations in this interim review, which identifies clear areas where improvement is urgently needed.

“Many of these align with areas we have prioritised as part of our work to restore trust with the public and providers by listening better, working together more collaboratively and being honest about what we’ve got wrong.

“We are working at pace and in consultation with our stakeholders to rebuild that trust and become the strong, credible, and effective regulator of health and care services that the public and providers need and deserve.

“Work is underway to improve how we’re using our new regulatory approach. We’ve committed to increasing the number of inspections we are doing so that the public have an up-to-date understanding of quality and providers are able to demonstrate improvement.

“We’re increasing the number of people working in registration so we can improve waiting times. We’re working to fix and improve our provider portal, and this time we’ll be listening to providers and to our colleagues about the improvements that are needed and how we can design solutions together.

“We’ll be working with people who use services and providers to develop a shared definition of what good care looks like. And we’re also developing a new approach to relationship management that enables a closer and more consistent contact point for providers.

“Additionally, to strengthen our senior level healthcare expertise, we have appointed Professor Sir Mike Richards to conduct a targeted review of how the single assessment framework is currently working for NHS trusts and where we can make improvements.

“Sir Mike’s career as a senior clinician, and a distinguished leader of high-profile national reviews, as well as his direct experience of driving improvement through regulation, make him uniquely placed to conduct this work.”

The interim findings of the review have been published on GOV.UK.

Survey shows patient experiences in A&Es overall ‘very good’ – but improvements are needed

Responding to the latest urgent and emergency care survey published this week by the Care Quality Commission (CQC), Dr Katherine Henderson, President of the Royal College of Emergency Medicine, said: “The survey is welcome as it provides an invaluable insight into the patient experience and confirms that Emergency Departments are doing an incredible job in difficult circumstances.

“We are appreciative of patients engaging and providing this feedback in the middle of the pandemic in September 2020. Managing to continue these core assurance processes is a challenge but continues to be very important.

“It is encouraging to see improvements in many areas compared to previous years. It is particularly pleasing to see one-third of patients using type 1 services rate their experiences 10 out of 10, and also that 94% of patients had confidence and trust in the doctors and nurses examining and treating them. This is a testament to the dedication, commitment, expertise, and compassion of Emergency Medicine staff.

“While there are many positives to highlight in this report, understandably there are some areas for improvement. Many of the areas that are a source of frustration for patients are largely a result of staff shortages and the existing workforce’s ability to dedicate ample time to each patient.

“It is important that patients have the opportunity to talk through their treatment or condition, that all patients receive the help they need when they need it whether before, after or during their care, and that their pain or condition is managed throughout their time in A&E.

“The current challenges facing the health service are no doubt affecting clinicians’ ability to deliver the highest quality of care that they strive to provide. Current workforce numbers do not match current demand, and workforce shortages crossed with increases in demand mean existing staff are stretched thinly.

“To meet current demand the workforce needs 2,500 more consultants in England along with sufficient numbers of nurses, trainees, allied health professionals and SAS doctors.”

Dr Katherine Henderson continued: “It is interesting to see that 41% of patients contacted NHS 111 before going to A&E and 32% contacted their GP before going to A&E.

“This highlights the importance of NHS 111 as a resource for patients. It is absolutely essential that the efficacy of NHS 111 is properly evaluated so we can learn how best to resource it and wider services. Call handlers must have the tools they need to provide sound guidance to patients, and they must have an adequate range of services and pathways to which they can direct patients.

“It is also significant that 32% of patients also contact their GP before going to A&E. This highlights the crucial link between primary and urgent and emergency care and makes clear that both are under-resourced. Plans to tackle the challenges facing urgent and emergency care must include a joined-up approach that include ways of supporting and resourcing primary care.”