The Care Quality Commission’s annual report has highlighted that safety levels across the NHS and care sectors are of “significant concern”, with safety issues being identified at three-quarters of hospitals visited since the launch of its new inspection regime in April 2014.
Inspections have so far been conducted at more than 5,000 NHS organisations, including 11% of GP surgeries, 17% of care services and nearly half of all hospitals. The quality of management, safety and care are some of the key issues which the CQC’s experts have been called upon to consider throughout the inspection process.
Worryingly, following the inspections some 13% of hospitals were deemed unsafe, together with 6% of GP services. A further 10% of social care facilities were judged “inadequate” (the lowest possible rating) for safety.
Among some of the safety issues identified in the report were:
- staff not receiving essential training and not undertaking mandatory courses – in particular, the report revealed that staff at a GP surgery had not undergone basic life-support training in the last 18 months;
- inadequate management of medicines – medication mistakes were identified at a care home, including delays administering drugs and signs of overdoses;
- incomplete safety checks and audits;
- poor management of patients at risk of health complications;
- a disregard for infection control processes.
According to the report, the key to addressing these issues is good leadership both at trust level and clinical team level.
The Frimley Park Hospital NHS Foundation Trust was cited in the report as a key example, having been rated as outstanding in September 2014. The Trust was praised for the strength and depth of its leadership, and the way in which staff worked together across the Trust. At the same time, The Frimley Park Hospital NHS Foundation Trust was said to have demonstrated a “strong safety culture”, which staff regarded as a priority.
The CQC’s chief executive, David Behan said that the inspections had found a “wide variation in the quality of care people receive”, adding that the purpose of the inspection regime was to highlight those services providing poor care in order to “drive up standards”. The case of Basildon and Thurrock University NHS Hospitals Foundation Trust is clear evidence of the effectiveness of this approach, having been rated as “good” by the CQC following initiatives to improve services which came about after the Trust was placed in special measures in June 2013.
The report also sets out the steps the poorly rated NHS organisations must now take to improve the standards within services. These include:
- identifying clear objectives in collaboration with staff throughout the organisation;
- supporting learning and innovation in all staff;
- creating a culture of openness whereby staff feel empowered to raise issues and make suggestions for improvement;
- supporting patients through the complaints process, reassuring them that raising a complaint will not negatively impact the standard of care they receive.
Whether and to what extent these measures will serve to improve standards across other NHS services remains to be seen. Care Quality Commission chief executive Mr Behan was clear that, in his opinion, patients should not avoid attending hospitals that had received poor safety ratings as this could place excessive pressure on those trusts that have performed well. However, it seems inevitable that hospitals which have achieved a good rating will attract more patients in an era of increased patient choice.
We will watch the progress of the trusts involved with interest and hope that those that received poor ratings can use this as a catalyst for positive change in the future.