CQC report highlights unfair and unacceptable waits for care

NHS leaders have said that the new State of Care report from the Care Quality Commission (CQC) should make ‘deeply uncomfortable reading’ for the government as it highlights a crises on multiple fronts and the need for urgent NHS support and investment.

The report, which looks at the quality of health and social care over the past year, found that the cost-of-living crisis and workforce pressures have escalated leading to unfair care.

It also found that the number of people on waiting lists for treatment has grown to record figures and in the face of longer waits, those who can afford it are increasingly turning to private healthcare. Research by YouGov shows that eight in 10 of those who used private health care last year would previously have used the NHS, with separate research showing that 56% of people had tried to use the NHS before using private healthcare.

The NHS Confederations said that the ‘sobering’ report lays bare the critical state that the NHS is in and should provide a salutary warning to political leaders about the abundance of issues facing the health service and the scale of the recovery task ahead.

Matthew Taylor, chief executive of the NHS Confederation, added: “After a decade of under-investment in staff, buildings and infrastructure, it is no surprise that we are in this position. We now need a credible plan that helps NHS leaders recover services and rebuild public confidence in what has always been one of the UK’s most valued institutions.

“The report is rightly at pains to point out that there is good work happening across all of the sectors in very tough conditions, particularly around mitigating the risks of staffing shortages, but health leaders will all too readily recognise the many intractable problems outlined within it.

“There are over 7 million on elective care waiting lists, increasing delays in A&E, notable declines in maternity, mental health and ambulance services, insufficient capacity in adult social care, and continued issues with access in primary care and dentistry – that one patient resorted to pulling their own teeth out due to a lack of available NHS dentists should be a source of shame for the sixth largest economy in the world.”

CQC highlights worsening health inequality

According to the CQC, this situation is likely to exacerbate existing heath inequalities and increase the risk of a two-tier system of health care, with people who cannot afford to pay waiting longer for care. CQC’s adult inpatient survey, based on feedback from over 63,000 people, found that 41% felt their health deteriorated while they were on a waiting list to be admitted to hospital.

The King’s Fund said that history has shown us that a slow slide towards a two-tier health service can be avoided through a concerted effort to bring down NHS waiting lists, led and funded by government.

Sally Warren, Director of Policy at The King’s Fund, added: “Public satisfaction with the NHS is at a record low. Despite this, and despite signs that some people are paying for care out of their own pocket while others simply go without, public support for the founding principle of services being free at the point of use remains rock solid.

“The report also highlights key areas where leaders across the NHS need to take action to ensure an equitable, fair and compassionate culture across their local teams, organisations and systems. Examples stretching from racial stereotypes in maternity care, or inappropriately restraining patients in mental health settings, shows that leaders have work to do to create a culture focused on ensuring teams are enabled to treat all patients with care, compassion, dignity and fairness.”

Social care buckling under pressure

The State of Care analysis also examined the impact of local authority budgets failing to keep pace with rising costs and the increase in the number of people needing care. It said that there is the risk that people who live in more deprived areas who need local authority funded care, may not be able to get the care they need.

In addition, private providers are struggling to pay their staff a wage in line with inflation, which affects recruitment and retention as well as quality of care. Data from CQC’s Market Oversight scheme shows that care home profitability remains at historically low levels.

The Health Foundation said the report shows that the ongoing strains on NHS and social care services and new data also show that fewer people accessed long term support in 2022 than in 2015, despite growing demand.

Tim Gardner, Assistant Director of Policy, said: “Long-term underfunding and chronic staffing shortages across health and social care mean that many people are going without the care they need. Those who can afford to are increasingly turning to private care while others are having to rely on family and friends. Unpaid carers are now spending longer caring for loved ones, potentially widening inequalities as those who provide the highest levels of unpaid care are more likely to come from lower-income households.

“Given that public support for government policies on the NHS and social care is low, this report should be a wake-up call for policymakers. As we head towards the next general election, the main political parties must set out concrete plans for addressing the underlying causes of these pressures – including investing in and reforming our broken social care system.”

“All systems need clear and realistic goals – and support to achieve these – that reflect how they will address unwarranted variations in population health and disparities in access, outcomes, and experience of health and social care.

“This opportunity must be grasped to ensure fairer care for everyone – so people get the care they need, not just the care they can afford.”

Ian Dilks, Chair of CQC

Mental health care is a key area of concern

The State of Care report found that access to and quality of mental health care also remain a key area of concern. Gaps in community care continue to put pressure on mental health inpatient services, with many inpatient services struggling to provide a bed, which in turn leads to people being cared for in inappropriate environments – often in A&E.

One acute trust reported that there had been 42 mental health patients waiting for over 36 hours in their emergency department in one month alone. When people do get a bed in a mental health hospital, the quality of care is often not good enough. Safety continues to be an area of concern, with 40% of providers rated as requires improvement or inadequate for safety.

Recruitment and retention of staff also remains one of the biggest challenges for the mental health sector, with the use of bank and agency staff remaining high and almost one in five mental health nursing posts vacant. CQC has raised concerns that staffing issues in mental health services are leading to the over-use of restrictive practices, including restraint, seclusion, and segregation, and called on providers to recognise and take steps to address this.

CQC say maternity services under huge pressure

CQC said it has continued its focused programme of maternity inspections, with the overarching picture of a service and staff under huge pressure emerging. Ten per cent of maternity services are rated as inadequate overall, while 39% are rated as requires improvement. Safety and leadership remain particular areas of concern, with 15% of services rated as inadequate for their safety and 12% rated as inadequate for being well-led.

It added that while it has been encouraging that all units inspected so far have adjusted consultant cover to meet recommendations made in the Ockenden report, the cover model is often fragile, with rotas reliant on every consultant being available. We have seen examples of services taking action to manage staff shortages safely – but we have also seen issues with governance and lack of oversight from Boards, delays to care and lack of one-to-one care during labour, as well as poor communication with women and difficult working relationships between staff groups.

Additionally, women and babies from ethnic minority groups continue to experience higher risks around birth. Infant mortality rates for Black and Asian babies are still higher than for any other group and readmission rates of Black women during the 6-week postpartum period continue to rise and are significantly higher than for women of other ethnicities.

Alongside its programme of maternity inspections, CQC commissioned a series of interviews with midwives from ethnic minority groups to explore their experiences of working in maternity services and their insights into safety issues. A common theme from these interviews was that care for people using maternity services is affected by racial stereotypes and a lack of cultural awareness among staff.