State of care report 2018/19 released by Care Quality Commission

The annual assessment of the state of healthcare in England has been published by the Care Quality Commission.  The report – the State of Healthcare and Adult Social Care 2018/19 – has a particular focus on mental health services this year. The CQC’s headline is that “Growing pressures on access and staffing risk creating ‘perfect storm’ for people using mental health and learning disability services.”

The report notes that A&E services are struggling with 44% of emergency departments in England rated ‘required improvement’ and another 8% rated ‘inadequate’. Last year 48% of A&Es fell into the two ratings brackets combined. The reason noted is a sustained year-on-year rise in attendances at A&E as patients struggle to access other services, in particular mental health services.

In mental health services, the CQC has found “a real deterioration in some specialist inpatient services” and at 30 September 2019:

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

The CQC reports that 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.

The report notes that its inspectors have 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.” A lack of appropriately skilled staff was identified as an issue in the inspection report in the majority of mental health inpatient services that were rated ‘inadequate’ or ‘requires improvement’.

A major factor is a lack of long-term sustainable funding solution for adult social care, which is having a damaging impact on the quality and quantity of available care, noted Peter Wyman, Chair of the Care Quality Commission. He added that “There is an urgent need for this solution to be prioritised by Parliament and Government – the failure to find a consensus for a future funding model continues to drive instability in this sector.”

The State of Care report draws on quantitative analysis of inspection ratings of almost 32,000 services and providers, in addition to other monitoring information including staff and public surveys, and performance. It also draws on qualitative analysis of interviews and focus groups with CQC inspection staff and voluntary organisations, secondary analysis of ‘Share Your Experience’ comments and inspection reports, and case studies of the experiences of people who use services and innovative providers.

The full report can be downloaded from the CQC website here, 15 October 2019