CQC reveals comprehensive picture of the quality of hospital care in England

The Care Quality Commission (CQC) today publishes a report on the findings from its first round of acute and specialist hospital trust inspections.

The report shows variation in the quality of hospital services – but also highlights those hospital trusts that have been able to make practical changes to the way they deliver care and are seeing improvements to patient care as a result.

This is the first time such a focused national analysis has been possible, following the introduction of CQC's new comprehensive inspection programme in 2013. Since then, CQC has completed inspections of all 136 acute non-specialist and all 18 specialist trusts, and now has a more detailed understanding of the quality of NHS care than ever before – at trust level, but also at an individual core service level. These comprehensive inspections have helped trusts to understand the specific areas where improvements are needed and to take targeted action and have provided increased transparency on performance for people who use services.

CQC's analysis shows variation both in the quality of care between hospitals and between individual core services within the same hospital. While the majority of hospital services are delivering good quality care and looking after patients well, inspections have also uncovered pockets of poor care even in good hospitals.

Professor Sir Mike Richards, CQC's Chief Inspector of Hospitals, said: 

"We have now inspected every hospital in England and have a unique picture of the quality of care, right down to individual core services. We have witnessed some fantastic care and examples of innovative practice, but we have also found a wide variation in quality both between hospitals and between services within the same hospital.

"Safety remains a real concern, often due to a failure to learn when things go wrong. Strong leadership that instils a culture of learning and an environment where staff are listened to can play a vital part in bringing about improvements. But compassion is alive and well, with caring the most highly rated of the five key questions – overwhelmingly, we see staff behaving in a caring way, which is supported by what we hear from patients. The unwavering dedication and commitment of staff shines out from our inspection reports.

"What is clear is that while staff continue to work hard to deliver good care, the model of acute care that once worked well cannot continue to meet the needs of today's population. The NHS now stands on a burning platform – the need for change is clear, but finding the resources and energy to deliver that change while simultaneously providing safe patient care can seem almost impossible.

"What this report demonstrates, however, is that transformational change is possible, even in the most challenging of circumstances – we have witnessed it, and seen the evidence that making practical changes to the way that care is delivered can benefit patients. In this report, we have highlighted good practice so that others can learn from it, be inspired by it and adapt what is relevant to use in their own improvement journey. Moving away from an insular approach and actively sharing learning between organisations will be increasingly vital if the whole system is to move forward together."

Across all acute trusts, critical care services and services for children and young people have received the most ratings of good and outstanding (66% and 68% respectively). Of all the core services CQC rates, urgent and emergency services have received the highest number of inadequate ratings (9%) followed by medical care (5%).

This reflects the fact that many Accident and Emergency departments are struggling to cope with ever increasing attendances. It also shows the challenges that increased demand has created for managing patient flow throughout other hospital departments and wards, often compounded by delayed discharges which are linked to problems in the wider system, for example a lack of capacity within community health services or the social care system.

Despite the well-documented challenges that the NHS faces, CQC has found much good and outstanding care and has awarded 'outstanding' ratings to five acute NHS trusts and five acute specialist NHS trusts. Also, 15 acute NHS trusts have exited special measures since July 2013 and have delivered innovative changes in order to do so.

The fact that a number of trusts have achieved major improvements, and in some cases moved from inadequate to good, is of great credit to the quality of leadership and the dedication and commitment of staff.

While safety of hospitals continues to be a concern, with 11 per cent of NHS acute specialist trusts rated inadequate for safety, those trusts rated good for safety have an open and honest culture where all concerns are listened to and any issues identified are acted on and learnt from.

CQC's analysis shows that good leadership is critical in ensuring that people receive safe effective and responsive care and in driving improvement. Where the leadership teams have viewed CQC's findings as an opportunity to drive change they were more often able to make rapid improvements. In addition, strong leadership at ward and board level, a culture where staff are valued, along with collaboration with local healthcare partners have all been shown to be major factors in delivering sustainable high quality care.

Equally important to note is that caring is the most highly rated of the five key questions in acute hospitals. At trust level, no trust has been rated as inadequate for caring and, overwhelmingly, CQC reports describe staff behaving in a caring and compassionate way.

Having carried out a comprehensive inspection of every NHS trust in England at least once, CQC has a more detailed understanding of the quality of NHS care than ever before and a baseline against which it can continue to monitor and measure the quality of acute hospital care in England. The quality regulator has recently consulted on plans to use that understanding, together with improved systems for gathering intelligence, to move towards more targeted inspections for NHS trusts. The CQC expects to formally respond to the feedback from the consultation in spring 2017.

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