Care Quality Commission: Future of the NHS is precarious

The NHS is straining at the seams as it juggles problems with staffing shortages, rising demand and increasing numbers of patients with preventable illnesses, health and care inspectors have said.

The NHS is straining at the seams as it juggles problems with staffing shortages, rising demand and increasing numbers of patients with preventable illnesses, health and care inspectors have said.

'Staffing issues are making an impact on quality of care' says CQC Sir David Behan.

A new Care Quality Commission (CQC) report warns that healthcare services are fully stretched and the quality of future care is precarious.

It said the NHS is 'struggling to cope with 21st century problems' including increasing numbers of people with illnesses linked to lifestyle choices, like obesity and heart disease.

As well as coping with new demand, the service works with insufficient staff numbers in some areas, the regulator added – highlighting a particular shortage of nurses in care homes.

The new CQC report is based on the regulator's inspections across the health and care sector in England including hospitals, ambulance services, GP surgeries and mental healthcare.


Overall, the regulator said that, compared with last year, the quality of care was maintained thanks to staff efforts but health and care workers are under huge pressure and staff resilience is not inexhaustible.

The report said the number of vacancies across all NHS settings rose by 16% from March 2015 to March 2017.

'There are some areas where there are clearly insufficient staff – I'm calling out the availability of nurses in nursing homes,' said CQC chief executive Sir David Behan.

'But some of this is not just about the quantum of staff available, but how your staff are deployed and made available.

'These are staffing issues which are making an impact on quality of care.'

The report told of increasing numbers of frail older patients, many who have dementia, and more people with long-term complex conditions placing unprecedented pressure on the system. It says future quality is precarious as the system struggles with increasingly complex demand, access and cost.

Meanwhile, some services previously rated as good deteriorated when reinspected.

Ratings drop

Inspectors found that among services it reinspected last year, 26% of mental health services and 23% of adult social care services originally rated good dropped at least one rating.

Two out of the 11 NHS acute hospitals reinspected also fell in ratings. CQC said safety remained its biggest concern.

As of 31 July 2017, 5% of acute hospital core services were rated as inadequate for safety, as were 3% of core services in NHS mental health trusts.

Meanwhile, 11% of hospital EDs were told the safety of their service was inadequate and 55% were deemed to need improvement – meaning 66% were not performing well enough.

Sir David added: 'The fact that the quality of care has been maintained in the toughest climate that most can remember is testament to the efforts of frontline staff, managers and leaders.

'Many providers have used our inspection reports to improve and we have seen improvements in safety in particular, although this area remains a big concern and focus for us.

'However, as people's health and care needs change and become more complex, a model of care designed for the 20th century is at full stretch and struggling to cope with 21st-century problems.

'Staff and leaders can't work any harder; the answer must be to work more collaboratively, not just between sectors, but between agencies and professionals, supported and incentivised by the national health and care organisations.'

Commenting on the report England's chief nursing officer Jane Cummings said: 'It's good that the CQC has found widespread improvements across the NHS, with many more hospitals, mental health services and GPs rated better than last year.

'Progress in the face of great pressure is a testimony to NHS staff. The CQC rightly highlights the rising health and social care needs of older and vulnerable people of all ages, which clearly require a sensible funding solution.'


Health minister Philip Dunne said: 'Today the CQC has again recognised that the vast majority of patients are getting good care and many parts of the NHS have improved.

'We are determined to make the NHS the safest healthcare system in the world and are investing in more staff and in services.'

Further information

The state of health care and adult social care in England 2016-17

In other news