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State of Care

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State of Care 2014/15

England's health and social care system is under pressure. Changing care needs and tough financial demands have contributed to an environment where higher quality is hard won. But our inspections show that improvement is possible, and we must look to the best to understand what works and why.

Cover of the State of Care 2015 report

For the first time, our State of Care report draws on findings from our new, more thorough inspections across all of the sectors we regulate. From this, we're starting to build a comprehensive picture of quality across England and identify the elements that drive high-quality care.

Challenging times

Care providers are being asked to make savings and meet the more complex needs of an ageing population, while ensuring that the health and care system can survive and remain financially stable in the future.

  • The NHS has had to cope with increasing pressure but budgets have seen smaller increases than before.
  • Adult social care providers have been asked to do more for less, as local authority funding has been reduced.

Our findings

Despite these pressures, many providers have managed to improve or maintain quality.

Overall ratings by sector

  • However, some people are receiving care that's unacceptable: of the providers we'd rated by the end of May 2015, 7% were inadequate.
  • Quality is variable: there are large differences in the quality of care people receive – between different services and different care providers.
  • Sometimes quality varies according to who you are or what you need. For example people with mental health needs and long-term conditions and some ethnic minority groups are less likely to report good experiences of care.
  • Safety is our biggest concern: of the services we've rated so far, 13% of hospitals, 10% of adult social care services and 6% of GP practices were inadequate for safety.

Improvement is possible

By the end of May 2015, we'd re-inspected 123 of the services we had already rated.

  • 50% had improved.
  • Fewer than 7% had deteriorated further.
  • All of these re-inspections took place within a year of the original rating.

What makes high-quality care?

From the evidence we've analysed, we don't believe that more money is the answer to delivering higher quality care. By looking at services rated outstanding or inadequate, we've found three areas that play a critical part in quality improvement.

Engaged leaders building a shared ownership of quality and safety

We've identified five critical aspects of good leadership:

  • Effective engagement and communication with staff and people using services.
  • The skills, experience and visibility of management.
  • A strong and positive organisational culture.
  • Learning when things go wrong.
  • Governance processes to support and underpin success.

Staff planning that goes beyond simple numbers

Our inspectors look at staffing when they assess whether services are safe across all of the sectors we regulate.

  • But this isn't just about having the right number of staff.
  • It's also about having the right mix of staff with the right skills to meet people's needs.
  • Staff training and development are also important.

Working together to address cross-sector priorities

Ensuring the resilience of the health and social care system and improving and maintaining quality will require coordination and collaboration both at a national and local level.

  • Services and different parts of the system must work together to ensure the sustainability of health and social care.
  • All sectors must improve their ability to recognise safeguarding issues through good staff training and shared learning.
  • Data must be collected across all sectors to enable a good understanding of what works.


Last updated:
31 August 2016