The annual “State of Care” report was published by the Care Quality Commission (CQC) on Friday 23 November.
This is an annual report on the state of care services in England and the quality of care that they provide. It is based on over 1,300 inspections, so it comes with some authority about the general state of care in the country.
Amongst its key findings are the following:-
- 1 in 10 NHS Hospitals fails to treat people with the respect they deserve and to involve them in decisions about their own care.
- 15% of social care services are not providing care that treats people with appropriate levels of respect.
- 23% of the institutions inspected did not have adequate staffing levels.
The report notes that there has been an increase generally in people with complex or multiple illnesses partially as a result of an increasingly ageing population. There has also been a growing demand for nursing care in the community and in social care settings. As a result there has been an increase in nursing homes, but the number of residential non-nursing care homes has fallen.
In some cases there are sufficient numbers of staff but the skill mix is inappropriate. There is a lack of skilled experienced personnel and perhaps a reliance on unskilled assistance with limited or no experience.
Overall the CQC found three factors which contributed to poor quality of services.
- Firstly providers of services who managed their businesses with a high vacancy rate or simply a wrong mix of skills.
- More importantly, an attitude to care that was task-based rather than looking at the holistic and all-person approach.
- Further and more worryingly, a care culture that found unacceptable practice to be fairly normal.
Leaving aside the issues of basic care, the general conclusion was that there were some institutions which were providing services which did not preserve the dignity of their clients.
It is a frankly astonishing that almost a quarter of the homes inspected did not have adequate staffing levels .These are the nursing homes which provide for complex health needs. 16% of hospital services failed to meet the staffing requirement levels that the CQC considered appropriate. This is a significant number of hospitals failing to provide sufficient staff to deal with care needs of patients.
The other issue which was equally important, particularly for lawyers, is that as a result of the increased pressure on limited employees, the level of appropriate record-keeping was deteriorating. In addition, so was the management of medicines.
As lawyers we depend a great deal on the medical records that were contemporaneously completed. In the private sector medical records can often be poor. In the NHS sector they tend to be more thorough. It is a worrying aspect of the report that across the board record-keeping was beginning to deteriorate. Not all institutions were poor, but a significant minority were not providing the level of record-keeping that should be expected.
The consequences of this for the patient are that continuity of care becomes a problem. There may be drug errors in any event, but also in terms of legal action it becomes a much more complicated matter when the records are inadequate.
It is a fact of life that as people get older, they tend to have additional medical problems. These can be complex and need appropriate integrated care and control. What appears to be happening more and more is that this level of care is not being provided in some institutions and only the very basics are being done.
The CQC is independent of health and social care services. Its role is very much to ensure that the care provided meets national standards of quality and safety. It does have powers to take action where people are receiving poor care, but the sheer scale of the inadequacy with which it is dealing must present it with some practical problems.
For clinical negligence lawyers it is likely that we will see an increase in potential claims to consider. What is worrying, however, in addition is that, as lawyers, we may not be able to ascertain fully what is happening because the medical records have not been completed properly.
Whilst by far the majority of inspections clearly demonstrated adequate care, there is a significant minority where the care does not meet the standard and where it is much more likely that serious accidents will occur. At the same time as the legal system is changing so that it will become more difficult for claimants to seek compensation for clinical negligence, we are dealing with a health care system which is failing a number of its own clients. The overall result may be fewer claims to the NHS and other bodies, but that does not mean that the negligence is not happening. It does not solve the problem of what happens after somebody has had an accident and requires further care as a result.
Overall the report is fairly depressing to read because at the end of those statistics there are vulnerable people who have very limited comeback against what is happening to them.