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Written on 24th October 2022 by Richard Money-Kyrle

Health and social care regulator, the Care Quality Commission (CQC), has published its report: The state of health care and adult social care in England 2021/22. The report warns that the health and care system is gridlocked, with delays in hospital admissions, discharge and emergency services leaving healthcare staff unable to provide safe care.

Maternity services are highlighted as an ‘area of deep concern’, which has failed to prioritise reducing risk by providing all women with access to safe, effective and personalised maternity care. People who are disabled or from deprived areas or ethnic minority groups are less likely to receive good care. Staff shortages and pressures are increasing, along with the risk to patient safety.

What is the Care Quality Commission or CQC?

The Care Quality Commission, often known as the CQC, is an executive non-departmental public body which is sponsored by the Department of Health and Social Care (DHSC). CQC regulates health and social care services in England to ensure the quality and safety of care, whether that care is provided in hospitals, ambulances and emergency services, care homes or people’s homes.

CQC's report is based on information gathered from CQC inspections, ratings, surveys and feedback from patients and carers, as well as national reports and published data.

Key findings from CQC’s State of Care report

CQC’s report, The state of health care and adult social care in England 2021/22, provides an overview of how current problems within the health and social care system are increasing the risks to patient care. Many of these concerns relate to well-known and ongoing issues that have been highlighted by specialist professional and regulatory organisations.

You can read more about what these organisations have reported here:

CQC’s key findings include:

  • In 2022 the health and care system is gridlocked

CQC says that gridlock within the health and care system has left it unable to operate effectively. This is leaving patients ‘stuck’ at various parts of their journey through the system and unable to access the treatment they need. Healthcare staff who work within the gridlocked system are unable to provide safe care. A group of 250 healthcare leaders told CQC that they were worried that the risk of people being harmed is becoming increasingly normal.

People are stuck in hospital because there is no social care in place for them when they leave. CQC found that only 2 in 5 (40%) people can leave hospital when they are ready to do so. This adds to record-breaking waits for people who are stuck in emergency (A&E) departments because there isn’t a bed for them in hospital for them to have the inpatient treatment they need. They are stuck in ambulances outside hospitals for dangerous lengths of time waiting for space to become available in A&E so that they can be handed over to A&E to have the emergency treatment they need. And those ambulances are stuck and unable to reach people who need transfer to hospital by ambulance and are left waiting for an ambulance to arrive.

CQC found that at every point along the urgent care pathway, the risk to people is increasing.

In 2021/22, around 24.4 million people attended A&E, nearly 7 million more than in 2020/21. This has a knock-on effect in other services, such as medical and elective care. Patients experienced long delays whilst waiting to be prioritised for treatment (triaged) in A&E and then in being seen by a doctor. In 2021/22 more than 5 million people had a longer than 4-hour wait in A&E compared with 3.5 million in 2019/20. In 2021/22, there was a huge increase in the number of 12-hour or longer waits for admission to a ward after being seen in A&E. Figures from July 2022 show that the number of 12-hour or longer waits was 65 times higher than in July 2019.

In addition, people now tend to be more acutely unwell when they come to A&E, so they are more likely to need admission to hospital. This was also seen in increasing numbers of (life-threatening) category 1 ambulance calls, such as for cardiac arrest.

CQC’s ratings for urgent and emergency services in NHS acute hospitals remain unacceptably poor, with 54% rated as ‘requires improvement’ or ‘inadequate’ at 31 July 2022.

  • Queuing ambulances

Delayed handovers from ambulance to A&E are at unprecedented high levels. One in 10 ambulance handovers took over an hour in March 2022, against a standard of 15 minutes with nobody having to wait more than 30 minutes. The longest reported handover was 23 hours.

CQC says that ambulance handover delays are a consistent risk to the quality and safety of patients’ care. Even with good care by waiting ambulance crews, training for paramedics and emergency care assistants does not cover ongoing care and ambulances are not the right places for patients to receive emergency department care. Resulting delays in ambulance responses to 999 calls can result in serious injury or death to those needing ambulances for serious health conditions.

  • Discharge from hospital

Severe staff shortages in adult social care meant that in July 2022 only 4 in 10 patients could leave hospital when they were ready. Almost 13,000 patients a day spent more time in hospital than needed as a result of their condition.

  • Primary care and other contributing factors

CQC found that increasing demand for A&E services was made worse by patients not being able to get an appointment with a GP. This led to people either calling NHS 111 which then referred them to A&E or going to A&E directly.

Other contributing factors included staffing shortages, complex care pathways and lack of communication or coordination between different services.

In June 2022, more people than ever (6.7 million) were waiting for elective (non-urgent) NHS care and more than 350,000 people had waited over a year for treatment, more than 220 times higher than before the pandemic. The number of people waiting more than 18 weeks for treatment had reached an all-time high at over 2.5 million.

65,000 people in April to June 2021 chose to self-fund private treatment, compared with 50,000 people from April to June 2019.

  • Maternity services are an area of deep concern – care in 2 out of 5 maternity units is not good enough

CQC’s report highlighted maternity as a specific area of ‘deep concern’. Despite the many initiatives which have tried to improve the quality and safety of maternity care in recent years, CQC’s inspections continue to find issues with culture, leadership and a lack of genuine engagement with people using maternity services. They found that action to ensure all women have access to safe, effective and truly personalised maternity care has not been prioritised enough to reduce risk and prevent further tragedies from occurring. CQC found that not only has the pace of progress has been too slow, but their ratings at 31 July 2022 reveal a worsening of the quality of maternity services. 6% (9 out of 139) NHS maternity services are now rated as inadequate and 32% (45) require improvement.

Reports and reviews repeatedly identify the same concerns. Inadequate staff training, poor working relationships between obstetric and midwifery teams and inadequate risk assessment continue to affect the safety of maternity care. This is made worse when staff and women’s concerns are not heard or acted on.

Women from ethnic minority groups are known to have a higher risk of death during pregnancy and childbirth and are more likely to need readmission to hospital after giving birth than White women.  Black women are 4 times more likely and Asian women are twice as likely to die in pregnancy and childbirth than White women. The mortality rates for Black/Black British and Asian/Asian British babies are also higher than for those born to White women.

CQC concluded that the quality of maternity care in England is not good enough.  Worsening staff shortages, especially of midwives, are an urgent and continuing risk to the safety of mothers and babies. CQC has launched a new maternity inspection programme, to focus their resources on helping maternity services improve, both at local and national level.

If you, your partner or child have suffered serious injury as a result of medical negligence, you can talk to one of our solicitors, free and confidentially, to find out more about making a claim or responding to NHS Resolution or HSIB, by contacting us here.