Hospital Dr News

Patients being forced towards NHS hospitals due to lack of access elsewhere

Access to key services – or the lack of it – is pushing patients towards emergency departments and already busy hospitals.

That’s the conclusion of the CQC’s annual assessment of the state of health and social care in England, which suggests that many people are being forced into inappropriate care settings.

This year’s assessment considers the pressures faced by health and social care as a whole – but focuses particularly on inpatient mental health and learning disability services, the area where CQC is seeing an impact on quality.

Difficulties in accessing the right care can mean that people with a learning disability or autism end up detained in unsuitable hospitals.

While the overall quality picture for the mental health sector, which includes community mental health services, remains stable, this masks a deterioration in some specialist inpatient services.

As at 30 September 2019:

  • 10% of inpatient services for people with learning disabilities and/or autism were rated inadequate, as compared to 1% in 2018
  • 7% of child and adolescent mental health inpatient services rated inadequate (2018: 3%)
  • 8% of acute wards for adults of working age and psychiatric intensive care units (2018: 2%)

Since October 2018, 14 independent mental health hospitals that admit people with a learning disability and/or autism have been rated inadequate and put into special measures.

Two of these services have since improved, three are now closed and one service is still registered but is closed to new admissions with no people resident.

Although much good care has been witnessed, the CQC has also seen too many people using mental health and learning disability services being looked after by staff who lack the skills, training, experience or support from clinical staff to care for people with complex needs.

Where patients struggle to access non-urgent services in their local community, including GP and dental services, this can have a direct impact on secondary care services.

Figures for emergency admissions after attending the emergency department are continuing to rise year-on-year. This peaked at 31.2% of attendances in December 2018, and in July 2019 it was 28.9% – the highest figure for July in at least the last five years.

There has also been an increase in referral to treatment times over the last year, with 4.4 million people at the end of June 2019 waiting to start treatment – an increase of 40% since June 2014.

In adult social care, issues around workforce – including a lack of qualified staff – and funding continue to contribute to the fragility of the sector.

Ian Trenholm, Chief Executive of the Care Quality Commission (CQC) said: “Increased demand combined with challenges around workforce and access risk creating a perfect storm – meaning people who need support from mental health, learning disability or autism services may receive poor care, have to wait until they are at crisis point to get the help they need, be detained in unsuitable services far from home, or be unable to access care at all.”

Peter Wyman, Chair of the Care Quality Commission, said: “The fact that quality ratings across health and social care remain broadly stable – due to the dedication and hard work of staff and leaders – should be celebrated. But at the same time, we need to acknowledge that people’s experience of care is not always good – too many people are facing unacceptable challenges and cannot get the right care in the right place and at the right time.”

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