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Watchdog report finds staffing problems in NHS hospitals are exposing patients to danger from errors

Posted: 23rd November 2012

The Care Quality Commission (CQC) has published its most comprehensive ‘State of Care’ report. The report examines all care sectors for the first time and explores why some care services are failing to meet CQC standards.

With an increase in the number of people with complex or multiple illnesses, and the rising numbers of older people with dementia, the report notes a growing demand for nursing care within social care settings. This is reflected in an increase in the number of nursing homes registered with CQC in 2011/12 (the total rose by 1.4% [64 nursing homes] with a 3.3% increase in the number of registered nursing home beds). At the same time, the number of residential (non-nursing) care homes is falling.

Based on the evidence of over 13,000 inspections, the report suggests that pressures on care services are increasing the risks of poor or unsafe care for people who are less able to speak up for themselves and those, who as a result of their circumstances, are more vulnerable.

The report notes many examples of organisations that meet these challenges and deliver an excellent quality of care. But CQC’s inspectors on the ground also see others across both health and social care that are failing to manage the impact of these challenges effectively, and delivering care that is task-based, not person-centred. CQC’s Chief Executive David Behan says that this is unacceptable.

The report concludes that in some areas staffing and skill mix issues, combined with the need to care for people with increasingly complex conditions, are beginning to affect the quality of care being delivered, with a particular impact on the dignity and respect of people.

Where services fail, CQC has found three common factors which contribute to the poor quality of services:

- providers who try to manage with high vacancy rates or the wrong mix of skills;

- an attitude to care that is ‘task-based’, not person-centred;

- a care culture in which the unacceptable becomes the norm.

The report focuses on whether people receiving care - in the NHS, independent health care or adult social care - are treated with respect and dignity. Of the 350 inspections of NHS hospital services CQC carried out in 2011/12, 1 in 10 did not meet the standard on respecting and involving people in their care (equates to 35 inspections). In social care, 15% of the 2,502 inspections of nursing homes found a lack of respectful care (equates to 375 inspections).

Ensuring there are enough staff to provide a good service is a significant issue in many services. Of the 2,031 nursing homesCQC inspected, 23% (equates to 467 inspections) were not meeting the CQC standard of having adequate staffing levels, whilst 16% (equates to 603 inspections) of the 3,771 residential care homes CQC inspected were not meeting the same CQC standard. In the NHS, 16% of 250 inspections of hospital services (equates to 40 inspections) failed to meet the standard.

The increased pressures on care providers are also impacting on CQC standards - such as record-keeping and the management of medicines - that can be tell-tale signs of possible future problems of poor care.

The poor performance of some NHS hospitals in both medicines management (where from 150 inspections, 21% - equates to 31 inspections - failed to meet the standard) and record-keeping (where from 153 inspections, 22% - equates to 33 inspections - failed to meet the standard) is an indicator of where standards may slip as staff are stretched.

David Behan, Chief Executive of the CQC, said: “Our report highlights concerns we have that pressures on some services are leading to problems in the quality of care, keeping people safe, treating people with dignity and respect, and involving people in decisions about their own care. These pressures can not be used as an excuse to deliver poor care”.

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