Healthcare system is ‘gridlocked’, CQC finds

[THE CARE QUALITY COMMISSION’S annual assessment of the state of health and social care in England, published in October, is that the health and care system is gridlocked and unable to operate effectively. That conclusion is based on CQC’s inspection activity, information received from the public and those who deliver care, alongside other evidence.

Most people are still receiving good care when they can access it: too often, however, people are not able to access the care they need. Capacity in adult social care has reduced and unmet need has increased. Only two in five people are able to leave hospital when they are ready to do so, contributing to record-breaking waits in emergency departments following a decision to admit, and dangerous ambulance handover delays.

As part of the assessment – which included a series of co-ordinated inspections across the urgent and emergency care pathway in 10 Integrated Care Systems (ICSs) – CQC convened a group of 250 health and care leaders. They described the system they work in as ‘in crisis’ and shared their fears that the risk of people coming to harm represents a worrying new status quo.

Health and care staff want to provide good, safe care but are struggling to do so in a gridlocked system, the CQC says. That is reflected in growing public dissatisfaction with health and care services – which is mirrored in staff dissatisfaction. More staff than ever before are leaving health and social care and providers are finding it increasingly challenging to recruit, resulting in alarmingly high vacancy rates which have a direct impact on people’s care.

Without action now, staff retention will continue to decline across health and care, increasing pressure across the system and leading to worse outcomes for people. Services will be further stretched and people will be at greater risk of harm as staff try to deal with the consequences of a lack of access to community services, including adult social care.

In this year’s report CQC also highlights its concerns about specific service areas: in particular, maternity services and those that care for people with a learning disability and autistic people – areas where inspections continue to find issues with culture, leadership and a lack of genuine engagement with people who use services.

CQC’s chief executive Ian Trenholm commented: “The health and care system is gridlocked and unable to operate effectively. This means that people are stuck – stuck in hospital because there isn’t the social care support in place for them to leave, stuck in emergency departments waiting for a hospital bed to get the treatment they need and stuck waiting for ambulances that don’t arrive because those same ambulances are stuck outside hospitals waiting to transfer patients.

“There’s lots of great care out there – from the GP practice in Manchester carrying out ward rounds in care homes to the new initiatives introduced by a hospital in Newcastle-upon-Tyne which have improved people’s access to and experience of cancer treatments, to the ICS in Cornwall using inclusive technology to help give people more control of the services they use.

“However, the fact is that it’s hard for health and care staff to deliver good care in a gridlocked system. There are no quick fixes, but there are steps to be taken now on planning, investment and workforce that will help to avoid continuing deterioration in people’s access to and experience of care.”

Kate Terroni, chief inspector of adult social care and integrated care, and interim chief operating officer, added: “Through our inspection activity we see much good and outstanding care – as well as issues with culture and leadership which can lead to increased risk for people, as we’ve highlighted in maternity services and services for people with learning disabilities and autistic people.

“However, through our work on local areas and systems and our oversight of the whole health and care system, we also see increasingly clearly how a lack of investment in one part of the system has consequences for the whole, and the impact this has on whether people get good care.” q