The Care Quality Commission, the independent regulator of all health and adult social care in England, has just published its second annual report to Parliament.
It provides insight into the state of healthcare and adult social care in England, and shows that people have greater control over their care due to more choice in areas such as appointment times, choice of location of care and choice of providers.
However, it notes that while more people had access to personalised services through direct payments or personal budgets, there is still a wide variation in progress across the country.
The CQC says there are still some areas which have not improved fast enough, and stresses that it is vital that the advances already made become a key component of the newly emerging care system.
Its report says mental health services vary greatly in the extent to which they involve patients in planning their care and reviewing their treatment. CQC’s commissioners found that many services need to substantially improve their practices; a particular area of concern was that many detained patients who were certified as consenting to treatment, appeared to be refusing to give consent or lacked the capacity to do so.
CQC also found that the quality of private-sector run care services is generally lower than those run by councils or voluntary organisations. In April 2010, services run directly by councils and those run by voluntary organisations had the highest proportion of services rated good and excellent (91%), however they have a smaller fraction of the market. Privately run services had a significantly smaller proportion of good and excellent ratings (81%) - although this was a significant improvement on May 2008.
CQC’s chair, Dame Jo Williams, said: “There have been significant improvements in outcomes for people who use services and these services should be congratulated for the work they have done. However, the overall picture is far from perfect and it will be vital for all parts of the health and social care system to continue this upward trend and consolidate the best of what has worked well for people who use services.
“The next few years will be a crucial time for health and social care in England. There will be important changes such as the creation of Health Watch, Monitor as the economic regulator for health and social care, GP led commissioning consortia, Health and Well Being Boards and the National Health Service Commissioning Board. We hope that in the future, service providers and commissioners don’t lose sight of the good work that has already been done. The truly good care is care that is centred around the individual and tailored to their needs.”
Positives from the report
Overall there has been major improvement, including in areas that really matter to people. Waiting times for NHS Hospital treatment have shown progress, with the percentage of admitted patients treated within 18 weeks increasing from 48% to 86% between March 2007 and March 2008.
There was also a substantial increase in the number of care homes and home care services meeting safe care standards, including safe working practices and hygiene and infection control. However, the report finds that further improvement of medicines management is still needed.
The quality of care arranged by councils between September 2008 and September 2009 improved, with the percentage of people supported in care homes that were rated good or excellent improving by 11%, and 6% for home care agencies. Councils also made significant improvements in adult safeguarding and in maintaining the dignity and respect of people who are in a vulnerable position by commissioning better care.
Areas of concern
Too many patients - as many as 40% - said they were not told what danger signals to watch for after they went home from hospital. Around 45% reported that they did not have enough information about the side effects of medication.
Care services showed insufficient improvement in meeting standards relating to choice and control, this has been particularly prevalent in practices observed by our mental health Commissioners. Health commissioners were finding it difficult to balance spending on prevention while funding services for people with high level needs and some mental health services applied security measures in ways that placed unnecessary restriction on autonomy or compromised privacy.
Councils found it challenging to extend further options for independent living, and community-based services have been reduced. The rapid growth of demand for support, especially due to the rising number of older people, has not been matched by growth in the availability for more person-centred support. The number of people over 75 who had repeated emergency admissions increased, suggesting a lack of effective community support.
The quality of some mental health inpatient services continued to cause concern, for example where the CQC observed over-occupied inpatient wards, lack of one-to-one work with patients, or unnecessary restrictions of liberty.
Responding to the results, Mind’s chief executive Paul Farmer said: “It is disappointing to see that, while there have been recent advances in health and social care services across the board, care standards for people experiencing mental health problems are being left behind.
“These findings reinforce the importance of patient involvement and choice being at the heart of the new cross-government mental health strategy so that mental health has a ‘parity of esteem’ with physical health, finally giving the issue the equal footing it deserves.
“While the report shows that many people have greater control over their care, it is clear that the involvement of mental health patients in the planning of their treatment is patchy, with wide geographical variations. We are deeply concerned at the findings that many detained patients have been certified as consenting to treatment despite apparently refusing to give consent or lacking capacity to do so. It is also worrying that many voluntary psychiatric patients are treated in locked wards, depriving them of their liberty and removing their control over their care package.”
Louise Lakey, policy manager at Alzheimer’s Society, commented: “We know that home is where the heart is and where many people with dementia want to stay there. Yet this report suggests a lack of community services could be forcing some people into care homes earlier than they would want. With spending cuts beginning to take force it is essential we think long term and invest now in cost-effective, good quality care both in the community and in care homes.”
The CQC also pointed out that they are introducing a new system for regulating health and social care providers, which it claims will work much more in ‘real time’. “It will allow us to respond more quickly to poor standards of quality and safety where they are identified in order to improve outcomes for people who use services,” Dame Jo concluded.
Read the full report.
Tags: Social care, Waiting lists
