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State of Care 2012/13

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This is our annual report on the state of health and social care services in 2012/13.

Our findings

Our findings are based on the results of more than 35,000 inspections of hospitals, care homes, dental services, community services and more carried out by our inspectors in 2012/13.

What will this report tell you?

A look at accident and emergency

An increasing number of older people are being admitted to hospital in an emergency for an avoidable condition.

Pressure on A&E

As part of our State of Care report for 2012/13, we looked at the number of older people who have been admitted to hospital in an emergency for conditions that are generally avoidable.

Avoidable conditions are illnesses and sicknesses like:

  • bone fractures.
  • dehydration.
  • pneumonia.
  • respiratory infections.

We call them 'avoidable conditions' because they can be treated in the community (in homes or in community settings) or caused by poor care or neglect.

Avoidable admissions are rising

Over the last six years, the number of admissions for avoidable conditions has risen.

It has overtaken both:

  • the demographic growth in the number of older people.
  • growth in total emergency admissions among older people.

The number of people aged 75 and over who have been admitted to hospital in an emergency at least once during the year increased from seven per cent in 2007/08 to almost 10 per cent in 2012/13.

Increase of avoidable conditions

The number of admissions for some conditions have risen, including those for:

  • pneumonia: 64 per cent increase
  • inhaling food or liquid: 52 per cent increase
  • urinary tract infections: 45 per cent increase

People with dementia

Among people living in care homes, hospital admissions for avoidable conditions were 30 per cent higher for people with dementia.

Avoidable admissions and waiting times

At the same time, waiting times in A&E have also risen.

Annually, the proportion of people waiting more than four hours in A&E increased from two per cent in 2008/09 to four per cent in 2012/13.

There are similar trends between the increase of avoidable admissions and the increase in waiting times. They share the same quarterly and seasonal fluctuations and both substantially increased during the second half of 2012/13.

How well are health and social care services providing care?

You’ll find out how well the sectors below are doing around safety, effective care and support, respect and dignity, staffing and checking quality.

Adult social care

Despite some improvements, the care many people receive was still poor throughout 2012/13.

Our inspectors uncovered problems in more than 10 per cent of inspections across all types of adult social care services.

Nursing homes

  • One in five nursing home inspections revealed safety concerns – including failure to give out medicines safely or not carrying out risk assessments when starting to care for someone, and ongoing staffing pressures.
  • Out of all three types of adult social care settings, nursing homes need to make the most improvements around quality and safety of care.

Residential homes

  • We found a link between death notifications (sent to us by providers when a person dies in their care) and high staff turnover, which may result in gaps in care.
  • More than 10 per cent of inspections uncovered problems with either safeguarding and safety, staffing, or the care and support received by residents (for example, people not being helped to eat and drink enough).

Home care services

  • Problems with staffing and quality monitoring were uncovered in 10 per cent of inspections.
  • Home care managers must do more to prevent late and missed visits, support staff to carry out daily tasks and improve care planning.

Community social services

  • More than 10 per cent of inspections revealed issues around staffing in services like Shared Lives and supported living.


Our inspectors’ biggest concern around NHS hospitals in 2012/13 was that hospitals were not making improvements in assessing and monitoring the quality of care provided.

No improvements had been made in safety or in hospital patients being treated with dignity and respect.

Throughout the year, we carried out more than double the amount of enforcement action against services that were not meeting standards. It increased from three per cent in 2011/12 to seven per cent in 2012/13.

NHS hospitals

  • Our inspectors found poor care in around one in 10 of all hospital inspections.
  • The number of patients with dementia who died in hospital was more than a third higher (36 per cent) than patients in similar circumstances who did not have dementia, and they also stayed in hospital more than a quarter longer (27 per cent).

NHS Community health care

  • One in eight inspections still found that patient safety was being put at risk.
  • Staffing was also an issue, with one in 10 inspections finding a problem.

NHS mental health, learning disability and substance misuse services

  • Improvements were made to meet the care and welfare of people with a mental health problem or a learning disability, but we still uncovered problems in one in eight inspections.
  • Staffing problems still continued, with no improvement compared to 2011/12 and one in 10 inspections raising concerns.

Independent health care

During 2012/13, our inspectors saw a slight drop in the way hospitals assessed and monitored the quality of care.

Overall, safety remained the biggest issue for hospitals – with almost one in 10 inspections revealing standards not being met.

While mental health and learning disability services made improvements in 2012/13, they still lagged behind other independent services and there is still some way to go before they catch up.

There were significant differences in the care provided by private ambulance services. They were treating people effectively and with respect and dignity, but one in seven inspections raised problems around safety, staffing and monitoring.

Independent hospitals

  • Standards of care in 2012/13 were generally good.
  • Overall, hospitals did not improve the way they monitored quality.

Independent Community health care

  • Services performed very well in treating patients effectively and with dignity and respect.
  • Safety was still an issue, with almost one in 10 inspections raising concerns.

Independent mental health, learning disability and substance misuse services

  • Improvements were made in all five of our main areas of focus - and independent services almost matched the performance of their NHS equivalents.
  • Problems still remained in a number of areas, with safeguarding and safety being the biggest concern.

Independent ambulance services

2012/13 was the first year we inspected all private ambulance services, so this sets a benchmark for the sector going forward.

  • Our inspectors found that services provide effective care and treatment, and in every case we looked at, treated people with dignity and respect.
  • One in eight inspections uncovered problems around safeguarding and safety, staffing and assessing and monitoring the quality of the service.

Primary dental care

We have fewer concerns with the quality of dental care providers.

They are generally safe and most surgeries are clean with good infection control procedures.

Staff also know how to protect patients from the risk of abuse.

However, some services still need to make improvements as our inspectors saw safety problems in seven per cent of inspections.

Dental care services

  • Almost 99 per cent of inspections found that surgeries were very good at treating people with respect, listening to them and involving them in decisions about their treatment.
  • 40 per cent of the problems that our inspectors uncovered had either a ‘major’ or ‘moderate’ impact on patients.


Last updated:
3 September 2014