Poor medicines management and record keeping may be the first signs that staff are overstretched and could warn of more serious care failings, according to the Care Quality Commission.
The regulator’s annual “State of Care” report, published today, presents an analysis of the themes emerging from 13,000 inspections carried out by the CQC during 2011-12.
Almost a fifth of NHS hospitals inspected by the regulator failed to meet standards on medicines management, as did a quarter of NHS community providers and 17% of mental health trusts.
Common problems included poor storage and incomplete records that medicines had been administered to patients. A further 22% of NHS hospitals, 19% of community services and 17% of mental health services failed standards on record keeping.
The report said CQC inspectors had found poor record keeping was often an early sign of “strain” on an organisation, “for instance, as a consequence of a shortage of staff and the resulting lack of time they have to complete all their tasks”.
CQC chief executive David Behan 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.”
However, he said these pressures “cannot be used as an excuse to deliver poor care”.
The report found 16% of hospital trusts inspected were understaffed. Meanwhile, 23% of nursing homes and 16% of residential care homes were not meeting the CQC standard of having adequate staffing levels.
At the same time the report identified the growing demand for nursing care within social care settings and highlighted the growing pressure on staff from the increasing complexity of patients.
The CQC said 64 new nursing homes had registered with it during 2011-12 and there had been a 3.3% increase in the number of registered nursing beds. However, 15% of inspections of nursing homes found a lack of respectful care.
Crystal Oldman, chief Executive of the Queen’s Nursing Institute, said: “If more care is going to be delivered in the community, including in nursing homes, it is vital that there is more investment in well trained staff who have the time and the expertise to give high quality, compassionate and person-centred care to the most vulnerable members of society.”
In addition, the CQC report said more than 32,000 patients were admitted to hospital from care homes and went on to die there during 2011-12.
It said that, while some of these admissions may have been clinically appropriate, the fact a third of patients died within three days and half within a week suggested they could have been better cared for in their care home.
Most recent figures suggest 29% of people expressed a wish to die in their care home yet only 18% did so.
Jonathan Bruce, managing director of Prestige Nursing and Care, which provides agency staff to nursing and care homes, said it was “incredibly worrying” so many older people were not able to die in a location and surroundings they had chosen themselves.
Peter Carter, chief executive and general secretary of the Royal College of Nursing, said the report “echoed” RCN warnings that not enough hospitals, nursing and care homes were adequately staffed and, when coupled with the wrong mix of skills, was having a real effect on patient care.
“Already too many are failing to meet the CQC’s standards and this will only increase if action is not taken to improve staffing levels,” he said.
Mike Farrar, chief executive of the NHS Confederation, which represents managers, said staff, from the frontline to the board, needed to use the report to “scrutinise” the care they delivered.
He added: “We need to do more to encourage staff to speak out when they are unhappy about the standards of care or support provided on their ward.”