The Care Quality Commission checks whether hospitals, care homes and care services are meeting government standards. Visit our website at www.cqc.org.uk.

Access to care and services

In this section of the report, you can find out about our findings relating to when and where people access care services.

We have looked at access to care and services, using data published by the Department of Health, the Office for National Statistics and the NHS Information Centre as well as findings from the 2010 NHS inpatient survey.

The opportunity to access the right treatment, at a time and place that is convenient, is a priority for people using services.

In looking at these figures, we found that:

Over the first few months of 2011, there was a slight deterioration in waiting times for patients admitted to NHS hospitals. For outpatients, however, waiting times remained steady.
The number of inpatients admitted “as soon as they thought was necessary” has remained more or less the same for three years now at around 75 per cent. The same proportion said they were not given a choice about planned admission dates, another figure which has stayed constant.
The demand for social care services continues to rise. In the last year, the number of new contacts to councils responsible for social care rose by four per cent to 2.12 million. Of these, just over half resulted in a further assessment or commissioning of ongoing service.
Where the waiting time between first contact and completed assessment was known, more than a third were assessed within two days, and almost two-thirds were within two weeks, a slight improvement from the previous year. As with the previous year, five per cent overall waited more than three months for their assessment.
Evidence appears to show the reduction in social care budgets and increased demand is resulting in local authorities tightening their eligibility criteria for people to receive state-funded community care.

Case study
Mental health care in Somerset

A map showing the location of the Rydon Ward

Rydon Ward, a 32-bed ward caring for people with acute mental health needs, is part of Somerset Partnership NHS Foundation Trust.

It accommodates people detained under the Mental Health Act as well as voluntary patients. It has turned around services after CQC’s investigation found a number of concerns.

A review was triggered after four serious incidents involving patients occurred in 2010. Our initial report said that patients did not feel involved in their treatment and felt they had little input into their care plans. Staff that we spoke to felt they did not have sufficient training and, in particular, had concerns about having the skills to care of people with personality disorders.

Following the review, the trust put together a robust action plan to address them. When we returned for a follow-up, staff were much more confident in caring for the patients. They thought the specialist training on working with people with a personality disorder had been excellent. One person described it as “empowering”.

Everyone we asked said that they had received a copy of their care plan and felt more involved in their care. Staff were keen to expand the ways that they involved people. The ward has carried out a survey to see how involved people feel and responses were very positive.

Two initiatives in particular made a real difference. Firstly, communication of key risks were reviewed and especially the shift “handover”. The handover template was developed and audited weekly initially, to identify areas of good practice and those which needed further action. Once established, the frequency of the audits reduced but learning and good practice was shared trust-wide, with all inpatients wards continuing to audit handovers.

While the risks identified on the ward were considered by staff, these were not always recorded consistently. The ward held a multi-disciplinary review of the risks for each patient and recorded this on a daily basis, to ensure an up-to-date dynamic assessment for each patient.

Learning from these daily discussions prompted the development of a new risk screen within the electronic patient record, specifically designed to more accurately reflect the nature of the risks in terms of the most recent (acute) and the longer-term or historical risks. These changes will enable the ward staff to prioritise immediate and significant risk on the wards, while still considering previous risk history.

The trust’s Director of Operations said: “While being scrutinised is inevitably uncomfortable, we found processes made this a positive learning experience for everyone involved.”

Rydon’s Ward Manager said: “While this is happening, it is important to remember that we still have to deliver a safe service, so supporting staff while learning is essential.”