Hospital Dr News

Changing nature of NHS demand is placing “unprecedented pressure on the system”

The quality of NHS services is under threat as the system struggles with complex new types of demand, access and cost.

The Care Quality Commission’s (CQC) annual assessment of the quality of health and social care in England shows the the changing nature of demand – increasing numbers of older people with comorbidities – is placing unprecedented pressure on the system.

In acute hospitals, this means more people waiting over four hours at A&E; more planned operations cancelled, and people waiting longer for treatment.

And in adult social care, the number of beds in nursing homes has decreased across most of England and domiciliary care contracts are being handed back to councils because providers say the funding is insufficient to meet people’s needs; estimates show that one in eight older people are not receiving the help they need.

A minority of care was found to be failing people – between 1% and 3% of providers across the services CQC regulates were rated inadequate.

There is also much care that needs to improve: 19% (2016: 26%) of adult social care services; 37% (2016: 39%) of NHS acute core services; 24% (2016: 33%) of NHS mental health care services; and 6% (2016: 10%) of GP practices were rated as requires improvement.

Sir David Behan, Chief Executive of CQC, said: “The fact that the quality of care has been maintained in the toughest climate that most can remember is testament to the efforts of frontline staff, managers and leaders.

“However, as people’s health and care needs change and become more complex, a model of care designed for the 20th century is at full stretch and struggling to cope with 21st century problems.

“The impact of this on people is particularly evident where sectors come together – or fail to come together, as the complex patchwork of health and social care strains at the seams.”

He warned that the future of the social care system is “one of the greatest unresolved public policy issues of our time – a long term sustainable solution is urgently required”.

On the positive side, as at 31 July 2017, 78% of adult social care services were rated good (71% were rated good at 31 July 2016) as were 55% of NHS acute hospital core services (2016: 51%); 68% of NHS mental health care services (2016: 61%) and 89% of GP practices (2016: 83%).

Since CQC introduced its new approach to inspection and rating, there has been a clear improvement overall in safety across all of the sectors regulated and rated, it says.

Where CQC has seen improvements, providers have good monitoring that gives staff a clear, accurate and current picture, which allows risk to be assessed in real time, clear systems and governance in place, which enable learning from incidents and a positive culture where staff are encouraged to raise concerns.

Safety remains the CQC’s key. As at 31 July 2017, 5% (31 July 2016: 6%) of acute hospital core services were rated as inadequate for safety.

Dr Chaand Nagpaul, BMA council chair, said: “Now is not the time to rest on our laurels – A&E targets still aren’t being met, the number of people waiting more than 10 weeks for routine surgery is the highest it’s been in nine years and waits of a year or more are the second highest since 2012. The average waiting time for a GP appointment has hit two weeks, and many surgeries closed altogether last year.

“We are just one bad winter away from another crisis in our health system. The government should urgently bring spending on health in line with other leading European economies and produce a long-term strategy that addresses the fundamental workload and funding challenges that are overwhelming our health service.”

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