By John Tingle
The independent regulator for health and social care in England, the Quality Care Commission (CQC) has recently published its annual report on the real-time state of health and social care in England. It analyses trends, shares examples of outstanding, good, and poor health care care practices. It provides a true, unabashed account of issues facing the National Health Service (NHS) and health care delivery.
A Health System Stretched
There are commonalities, similar trends and challenges, found each year in the reports. A central message is that the NHS is stretched and is finding it difficult to meet current demands. This should come as no surprise. Ever since the NHS was founded in 1948 it has been short of resources and demand for services has always outstripped supply.
The report does acknowledge that the NHS must keep up with people’s needs today, and not as it was in 1948 when the NHS was formed: “Modern local services need to be designed around people’s needs that reflect society as it is in 2019-not as it was in 1948.”
Good Quality Care
Part 1 of the report gives an overview of issues and themes. The overall quality of care that people receive in England has improved very slightly from last year and most people receive good quality care. Many people, however, struggle to access care when they need it. Despite the care being good, they can face myriad challenges:
These challenges range across a spectrum. At one end, people may face inconveniences in getting appointments, chasing referrals and following up on previous visits. At the other end, people may be unable to get any help or service at all, compounded by difficulties in navigating their local health and care services and knowing where to turn.
The CQC state that there is variation in quality across England, which means that some populations in some regions may find it difficult to access good quality care.
The CQC notes “the relentless year-on year- rise in attendances at emergency departments and acute hospitals,” pointing out that “this trend has continued unabated over the last year, with urgent and emergency services bearing the brunt of this demand and struggling to provide high-quality care, with 44% rated as requires improvement and 8% as inadequate.”
Patient Safety, the Main Cause for Concern
NHS hospitals continued to provide good care during 2018/2019, with 65% of core services rated as good and 7% rated as outstanding. However, a cautionary note is sounded about safety, which remains the area of most concern for CQC, as 36% of services are rated as “requires improvement” and 3 % as “inadequate.”
Access to Care
Over the last year there has been an increase in referral to treatment times, with 4.4 million people at the end of June 2019 waiting to start treatment. This is an increase of 40% since June 2014.
The CQC report provides a valuable road map for the future delivery of good quality health care services. There are major problems identified, such as workforce issues and delays in accessing care. Worryingly, all these major problems can also translate into patient safety and litigation issues