The State of Health Care and Adult Social Care in England 2015/16 @Carequalitycomm

Care Quality Commission Care The state of health How to contact us in England and adult social care of health care The state care and adult social Call us on 03000 616161 care in England Email us at [email protected] Look at our website www.cqc.org.uk 2015/16 Write to us at Care Quality Commission Citygate Gallowgate Newcastle upon Tyne NE1 4PA 2015/16 Follow us on Twitter @CareQualityComm Read the summary and download this report in other formats at www.cqc.org.uk/stateofcare Scan this code on your phone to visit the site now. Please contact us if you would like this report in another language or format. CQC-347-410-102016 Care Quality Commission The state of health care and adult social care in England 2015/16 Presented to Parliament pursuant to section 83(4)(a) of the Health and Social Care Act 2008. Ordered by the House of Commons to be printed on 12 October 2016. HC 706 © Care Quality Commission 2016 The text of this document (this excludes, where present, the Royal Arms and all departmental and agency logos) may be reproduced free of charge in any format or medium providing that it is reproduced accurately and not in a misleading context. The material must be acknowledged as Care Quality Commission copyright and the document title specified. Where third party material has been identified, permission from the respective copyright holder must be sought. Any enquiries regarding this publication should be sent to us at [email protected] This publication is available at https://www.gov.uk/government/publications Print: ISBN 9781474137553 Web: ISBN 9781474137560 Printed in the UK by the Williams Lea Group on behalf of the Controller of Her Majesty’s Stationery Office. ID: 2905697 10/16 Printed on paper containing 75% recycled fibre content minimum. Contents Foreword 4 Summary 6 Introduction 10 Part 1: THE STATE OF CARE IN ENGLAND 12 1 Context 13 2 The quality of health and adult social care 16 3 Improvements in quality 33 4 The future resilience of health and social care 41 5 The future outlook 50 Part 2: THE SECTORS WE REGULATE 54 Adult social care 56 Acute hospitals, community health services and ambulance services 70 Mental health 90 Primary medical services 106 Equality in health and social care 122 The Deprivation of Liberty Safeguards 136 References 144 of services that we rated inadequate overall and 76% then re-inspected improved their ratings CQC STATE OF CARE REPORT 2015/16 3 Foreword This year’s State of Care report shows that, despite The financial challenges in the NHS have been increasingly challenging circumstances, much good extensively documented. Despite this, we have found care is being delivered and encouraging levels much good and outstanding care – particularly of improvement are taking place. However, the in children’s and young people’s services and sustainability of this position is in doubt. We are also critical care – which we highlight and celebrate. beginning to see some evidence of deterioration in We have given outstanding ratings to five acute quality, and some providers who are struggling to trusts and two mental health trusts, and five trusts improve their rating beyond ‘requires improvement’. have exited special measures since April 2015. The fragility of the adult social care market and the However, we have also found too much acute care pressure on primary care services are now beginning that we rated inadequate – particularly urgent to impact both on the people who rely on these and emergency services and medical services. And services and on the performance of secondary care. it will be increasingly difficult for trusts to make The evidence suggests we may be approaching a improvements to these services unless they are tipping point. The combination of a growing and able to work more closely with adequately funded ageing population, people with more long-term adult social care and primary care providers. conditions and a challenging economic climate means The quality of care received in NHS mental health greater demand on services and more problems trusts is broadly similar to that in acute trusts, for people in accessing care. This is translating to but with an even higher level of variability within increased A&E attendances, emergency admissions providers as well as between them. Community and delays to people leaving hospital, which in turn services are more likely to be rated good and is affecting the ability of a growing number of trusts outstanding than inpatient services such as to meet their performance and financial targets. wards for working age adults and psychiatric While large numbers of care homes and home intensive care units. In particular, we have care agencies are providing good quality care – concerns about the safety of acute mental health and three-quarters of those that we had rated services. Problems with the physical environment as inadequate, and then re-inspected, improved frequently contributed to a rating of requires – this still left a quarter of services originally improvement or inadequate for inpatient services. rated inadequate that did not improve enough The quality of care provided by primary medical to change their overall rating on re-inspection. services remains high. Despite a context of increased Through our market oversight function in adult demand, coupled with a shortage of GPs and social care, we also know that profit margins are increasing vacancy levels, 83% of the GP practices we reducing – both due to pressures on fees, and cost have rated so far are good and 4% are outstanding. pressures that include the national living wage. The challenge for this sector, as for the rest of the Already we are seeing some providers starting to system, is to consider what responses to increasingly hand back home care contracts as undeliverable; difficult conditions will maintain quality, now and local authorities predict more to come. Until in the future. Some general practices have formed recently, the growth in demand for care for new models of care, including joining together in people with greater care needs had been met by federations, and have involved people who use their a rise in the number of nursing home beds, but services in their conversations from an early stage. this bed growth has stalled since April 2015. 4 THE STATE OF HEALTH CARE AND ADULT SOCIAL CARE IN ENGLAND 2015/16 Last year we said that, to meet the challenges ahead, services needed to collaborate and leaders needed to think outside traditional organisational boundaries. We have since seen some cases where this is starting to happen, so we know it can be done. It now needs to happen more consistently, and faster. Our evidence suggests that finance and quality are not necessarily opposing demands; many providers are delivering good quality care within the resources available, often by starting to transform the way they work through collaboration with other services and sectors. We cannot ignore the impact of tough financial conditions on providers – but our focus will always be on quality and we will always act in the interest of people who use services. We will continue to highlight good and outstanding care, to support improvement and to take action to protect people where necessary. And we will continue to use the unique and detailed information we hold on quality to help those that lead, work in, and use health and care Peter Wyman services to make the right decisions. Chair People have a right to expect good, safe care from their health and social care services. Working with our partners, we will offer the system whatever support we can to make the changes necessary to ensure high-quality care into the future. David Behan Chief Executive FOREWORD 5 Summary Many health and care services in more than they budgeted for, often drawing on their England are providing good quality reserves to do so. Delivering high-quality care while care, despite a challenging environment, achieving good financial management is, therefore, but substantial variation remains more important and more challenging than ever. Many people in England are receiving a good Some health and care services are quality of care. As at 31 July 2016, 71% of the improving, but we are also starting to see adult social care services that we had inspected some services that are failing to improve were rated good and 1% were rated outstanding; and some deterioration in quality 83% of the GP practices we inspected were rated as good and 4% as outstanding; and 51% of the Despite the difficult environment in which providers core services provided by NHS acute hospital trusts are operating, some have been able to improve the that we inspected were rated as good and 5% as quality of care they provide. About three-quarters outstanding. There is much to be celebrated in the (76%) of those that we re-inspected following an way that many staff, managers and leaders across initial rating of inadequate achieved an improved the country deliver good, person-centred care. rating: 23% went from inadequate to good and 53% went from inadequate to requires improvement. But the quality of care across England still varies considerably, both within and between different However, improvement is far from universal. Almost services. Some people receive very poor care. We half (47%) of those services that we re-inspected rated a minority of services as inadequate: 2% following a rating of requires improvement did not of adult social care services, 3% of GP practices change their rating. And in 8% of cases, the quality and 5% of hospital core services as at 31 July of care deteriorated so much that we rated 2016.

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