The safety of NHS hospitals continues to be an area of “real concern”, according to a review of inspections, but compassion by nurses and other staff is “alive and well”.
While hospitals recognise patient safety as their top priority, it is frequently not translated into an “effective and consistent” safety culture, noted the Care Quality Commission.
“Frontline staff are the heroes of our reports”
The regulator highlighted that 11% of NHS acute specialist trusts had been rated as “inadequate” for safety, following one of its inspections.
It warned that, even in trusts rated as “good” for safety, its inspectors had found problems and areas where improvements could be made – for example, on record keeping or medicines management.
The Care Quality Commission has today published a report – The state of care in NHS acute hospitals: 2014 to 2016 – drawing together findings from its first round of hospital trust inspections.
The report shows variation in the quality of hospital services, but also highlights trusts that have made practical changes to the way they deliver care and are seeing improvements as a result.
It represents the first time such a focused national analysis has been possible since the introduction of its new comprehensive inspection programme in 2013, said the CQC.
“The NHS now stands on a burning platform – the need for change is clear”
The regulator has completed inspections of all 136 non-specialist acute trusts and all 18 specialist trusts, and now has a more detailed understanding of the quality of NHS care “than ever before”.
Its analysis showed variation both in the quality of care between hospitals and between individual core services within the same hospital.
While most hospital services were delivering good quality care and looking after patients well, the CQC noted that inspections had also “uncovered pockets of poor care even in good hospitals”.
Across all acute trusts, critical care services and services for children and young people had received the most ratings of “good” and “outstanding” – 66% and 68%, respectively.
In contrast, the CQC said 7% of urgent or accident and emergency services received “inadequate” ratings, reflecting that many were “struggling to cope with ever increasing attendances”.
Despite the challenges that the NHS faces, the regulator said it had found “much good and outstanding care”.
It has awarded “outstanding” ratings to five acute NHS trusts and five acute specialist NHS trusts, while 15 acute NHS trusts have exited the special measures support regime since July 2013. The acute trusts given the top CQC rating are:
- Frimley Health NHS Foundation Trust
- Salford Royal NHS Foundation Trust
- Western Sussex Hospitals NHS Foundation Trust
- Northumbria Healthcare NHS Foundation Trust
- Newcastle upon Tyne Hospitals NHS Foundation Trust
The “overarching message” from its inspections was that high quality care was found at trusts with effective leadership that had “worked hard to create a culture where staff felt valued and empowered to suggest improvements and question poor practice”.
In hospital trusts rated as “good” or “outstanding”, boards actively engaged with staff, asking them how they needed to improve, highlighted the regulator.
However, it warned that poor culture was often linked to difficulties attracting and retaining enough staff, which was a common problem identified by inspections.
“Nursing staff are doing the best they can but are being spread ever-more thinly”
The CQC noted that many hospitals had told it that staff recruitment was “one of their most difficult challenges”, often leading to over reliance on temporary and agency staff.
“For many of these same trusts, staff report high levels of work-related stress, bullying and discrimination, which are either not recognised or not sufficiently addressed by the trust, it said.
But, overall, the regulator praised the care given to patients by clinicians and their compassion and commitment, which had been revealed by its inspections.
“Frontline staff are the heroes of our reports. We have found high levels of compassionate care in virtually every hospital,” said the CQC.
“The exceptional daily commitment of staff has allowed hospitals to cope with the ever increasing demand, and the values and dedication of individual frontline teams are the fundamental factors in every good and outstanding service,” it said in its report.
However, it also warned that trusts needed to listen more to their staff in order to improve the quality of their services.
“We have found that many hospitals do not listen effectively to the views of their staff. This is having a major impact on their ability to provide safe, efficient, high-quality care,” said the CQC.
It noted that the “strongest voices” in its inspection reports were the many patients who spoke about the compassionate care they received and staff who reported concerns about the safety and quality of care, and the “daily frustrations of their working lives”.
Professor Sir Mike Richards, the 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.
“Safety remains a real concern, often due to a failure to learn when things go wrong. But compassion is alive and well,” said Sir Mike.
“Overwhelmingly, we see staff behaving in a caring way, which is supported by what we hear from patients,” he said. “The unwavering dedication and commitment of staff shines out from our inspection reports.”
But Sir Mike said the regulator’s inspections had also revealed the need for changes in the way services were delivered in order to meet growing demand.
“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,” he said.
“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,” said Sir Mike.
“What this report demonstrates, however, it 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,” he added.
Responding to the CQC report, Janet Davies, chief executive and general secretary of the Royal College of Nursing, focused on the need to improve hospital staffing levels.
“Safe staffing levels are not a luxury, they are a necessity,” she said. “Nursing staff are doing the best they can but are being spread ever-more thinly.
She added: “In next week’s budget, the government must give the NHS the money it needs to keep patients safe and wards staffed at the right level.”
Key findings from the CQC’s report on its inspections so far
NHS acute trusts overall ratings (136 trusts):
- 4% (5) Outstanding
- 29 (39%) Good
- 59% (80) Requires Improvement
- 9% (12) Inadequate
Across NHS hospitals, CQC rated 1,640 core services as:
- 80 – Outstanding
- 868 – Good
- 620 – Requires Improvement
- 81 – Inadequate