CQC publishes report on state of care in 2021/2022

The Care Quality Commission (CQC) has published their annual assessment entitled ‘The state of health care and adult social care in England 2021/22’.

The report explores trends in healthcare, highlights areas for improvement and shares examples of best practice. Here, we will take a look at the role of digital in the report.

Gridlocked care

One of the main problem areas highlighted is that of “gridlocked care”, noting long delays in ambulance times, a lack of available social care leading to large numbers of people waiting for discharge in hospital, and staff recruitment issues listed as key points in the report.

Alongside this, complex pathways are highlighted as a contributor. “People’s care pathways within and between services were complicated, and communication between providers was sometimes poor,” the report shares. “Sometimes mistakes were made where services were not working well together, but there was no learning because the providers were not sharing information… There were also delays in people’s access to services because of a lack of collaboration and poor communication – different digital operating systems within services was a barrier.”

System leaders were brought together in a workshop to discuss the improvements needed across urgent and emergency care pathways following completion of the report, and the good practice shared formed the basis for CQC’s new ‘PEOPLE FIRST’ resource which can be found here.

Ultimately, the report highlights a need for better communication and collaboration across health and care. It shares the positive impact digital can have in this area through a best practice example from Kent and Medway in which technology was used to provide quick access to patient information for out-of-hours staff.

Waiting for hospital treatment

NHS England data, shared in the report, shows that the waiting list for planned elective NHS treatment has grown steadily since June 2020 and by June 2022 there were more people than ever (6.7 million) waiting. CQC analysis indicates that this is an increase of over 50 percent since the start of the pandemic.

The report highlights a best practice example from Newcastle upon Tyne Hospitals NHS Foundation Trust, where two new initiatives were introduced to tackle the backlog and demand issues in more flexible ways. One of these initiatives involves a new ambulatory care unit (ACU) in which patient care pathways have been designed to reduce inpatient bed delays and unplanned admissions. Patients who would usually need to be admitted can now be treated at home using new technology in the form of a programmed infusion pump that can deliver treatment twice a day at home, and a remote system that monitors treatment delivery in real time. “People cared for through this ambulatory care pathway have given positive feedback to the trust,” the report states, listing benefits such as fewer delays and more involvement in decisions about care. The trust is currently planning to further expand its ACU pathways.

Children and young people’s mental health

Last year, CQC used their report to shine a light on the impact of the pandemic on mental health in children and young people, and raised concerns about providers’ abilities to meet increasing need.

They share a number of concerns in this area, including mixed communication between services and with families, with people not always aware of available support, and health inequalities made worse by the pandemic. “Digital technology enabled services to adapt overnight, ensuring continuation of care,” it comments. “But we heard that this could lead to risks such as staff missing cues or issues that would have been picked up face-to-face.”

Medicines safety: ambulance trusts and primary care

The report highlights the importance of correct prescription and administration of medicines, examining the role of pharmacy professionals in different settings.

Again, digital had both positive and negative aspects here. “We heard that prescribing by paramedics was sometimes made more challenging by IT problems,” the report comments.

However: “Some ambulance trusts were able to use digital systems to refer people to community pharmacists or primary care network pharmacists for a medication review. This ensured people received medicines safely and in line with their needs. It also helped reduce the inappropriate use of some medicines that can increase the risk of adverse effects associated with hospital re-admissions, such as falls.”

The importance of local partnerships 

“CQC has an important role to play in assessing and supporting providers and systems to improve,” the report states. “We will assess the way multiple health and social care providers work in partnership locally, checking that their focus is on improved experiences and outcomes for people.”

As part of this, the report highlights a best practice example for helping patients to become more involved in their own care, from an integrated care system (ICS) in Cornwall.

“They are working towards a patient portal following the 2021 launch of their patient hub,” the report shares. “The hub helps residents keep track of all their hospital outpatient appointment information – all in one place and accessible on a smartphone, tablet or computer.”

The ICS’s plans are part of a four-year digital strategy, the report continues, and that strategy “is clear that digital transformation must be planned around inclusion, otherwise there is a risk of increasing inequality of access.”

It adds: “Part of their plan is to introduce an ‘ICS in your pocket’, to transform people’s care pathways. This would be a facility to book and manage appointments, communicate with care staff and get health and wellbeing information. It could empower residents to manage their own care, in and out of hospital, with the potential to improve their experience, as well as supporting the ICS’s vision of ‘supporting people to help themselves and each other’.”

To read the report in full, please click here.