CQC: State of Care Report 2023/24 - Independent Healthcare

In its State of Care report in 2022, CQC commented on a healthcare system emerging from the pandemic and noted a system in gridlock. In this year’s report, CQC highlights that increased running costs and workforce challenges have escalated pressures on services even further, increasing health inequalities and producing a system where, increasingly, those who can afford to pay for treatment do so, and those who can’t face reduced access to services and longer waits whilst their conditions deteriorate.

Record high NHS waiting lists mean people are increasingly turning to independent healthcare; the CQC report cites YouGov research that 8 in 10 people who used private health care in the last year would previously have used the NHS.

Some key points arising from the report relevant to independent healthcare sector are:

Access to Care

• On NHS cancer waiting times, CQC report that 40% of patients are waiting more than two months from GP urgent referral to their first treatment for cancer (up from 22% in April 2019).
• In mental health, insufficiency of community care services continues to increase pressure on inpatient services, with a lack of available beds, leading to people being cared for in inappropriate environments.
• CQC note that its first look across local care systems, using its new powers to regulate local authorities and ICBs, shows that not all systems have sufficiently clear timeframes and measures in place to reduce health inequalities in terms of access to and experience of health and social care.

Quality of Care

• In mental health services (CQC do not differentiate between NHS and independent sector services), CQC state that safety concerns are increasing, with 41% of locations (up from 38% in 2022) rated as ‘Requires improvement’ or ‘Inadequate’ for the key question of ‘Safe?’.
• CQC report concerns in relation to medicines where care is shared between NHS providers and independent services, referring to evidence of clinicians prescribing controlled drugs to patients without the relevant medical and medication history.
• CQC note that private prescribing of Schedule 2 controlled drugs increased by 80% between 2021 and 2022; largely driven by the increase in prescribing for medicines licensed for ADHD.

Inequalities

• The pandemic and cost of living crisis have widened and exacerbated inequalities, both for people using health and social care services and those who work in these services.
• There remains unacceptable inconsistency in outcomes for autistic people with a learning disability. As well as reducing the use of restrictive practice, CQC comment that strong leadership is critical to improving equality of access to health services and to ensure better community based-options.

Deprivation of Liberty Safeguards

• The number of applications has continued to increase (by 11% since last year) and CQC remains concerned that the current system is unable to cope with the demand for assessments, leaving many in vulnerable circumstances without legal protection for extended periods.
• Only 19% of standard applications to deprive a person of their liberty were completed within the statutory 21-day timeframe, with the average application taking 156 days (over 7 times the statutory timeframe).
• The delay of the implementation of Liberty Protection Safeguards (“LPS”) is of concern. CQC state that those who are disabled or old are likely to be disproportionately affected by the decision to delay LPS.
• Remote assessments are often used to tackle local authority resourcing issues. However, CQC express concern that such assessments may not always provide enough detail to assess the care environment.
• There remains a concern that some providers have a limited understanding of the Deprivation of Liberty Safeguards (“DoLS”) framework, resulting in the overuse of restrictive practices and staff not always implementing the conditions attached to a DoLS authorisation.
• Some providers are not delivering adequate training on DoLS and there continues to be poor recording of mental capacity assessments.
• In mental health settings, there was a variable understanding of the interface between the Mental Capacity Act and the Mental Health Act and it was not always clear how staff decided that using the DoLS framework would be most appropriate for a particular patient.
• People subject to DoLS authorisations in mental health settings were not always clear about the details of their situation, and their families did not always understand the DoLS system and were not given information about their roles and rights.

Health and care workforce

• Although staffing numbers and vacancies were a recurring issue across the range of services inspected by CQC, with staff reporting that this impacted their ability to provide safe and effective care, CQC note that the independent acute health sector is maintaining good staffing levels.
• Providers are responding to workforce challenges in various ways, by being flexible with roles and capacity where possible and making considerable use of international recruitment. However, CQC report a growing trend of unethical international recruitment practices, and made 37 referrals regarding modern slavery, labour exploitation and international visas in 2022/23.
• The report recognises the significance of promoting the wellbeing of staff and building a culture that invests in staff and their wellbeing. There is a need to create supportive working environments and systems to address issues such as stress and burnout.

Ratings

CQC’s review of ratings for independent acute sector core services shows 93% with overall ratings of ‘Good’ or ‘Outstanding’ (an increase from 90% in 2022), and 86% rated as ‘Good’ or ‘Outstanding’ for ‘Safe’ (compared to 63% in NHS acute core services). To view the full ratings see Appendix: CQC ratings charts - Care Quality Commission. It will be interesting to see how the new Single Assessment Framework, soon to be introduced, will impact the overall ratings for services in the sector moving forward.

To read the full report, click here: State of Care - Care Quality Commission (cqc.org.uk)

If you would like to discuss the issues raised in this report in more detail, or have a regulatory query, please get in touch with Carlton Sadler, Partner, Siwan Griffiths, Partner or Amelia Bauer, Solicitor.