Quality and safety

In this section of the report, you can find out about our findings relating to the quality and safety of care services in England and the essential standards people can expect.

Quality and safety are at the heart of the essential standards and we are able to report our very early findings on a number of the outcomes set out by the standards.

We also draw on nationally published statistics and NHS patient surveys to give a rounded picture of quality and safety in the provision of care.

Our key findings in this area included:

• One of the outcomes we look at covers ‘effective, safe and appropriate care’. For both NHS and adult social care providers, failure to meet the regulations on this outcome was one of the three most common reasons why we served compliance actions.
• On safety and suitability of premises, care homes had the lowest proportions of compliance, and also the highest proportions of major concerns. Nine per cent of NHS hospitals had moderate concerns in relation to this outcome.
• We made unannounced inspections of 100 NHS hospitals to check whether older people were being treated with dignity and respect, and whether they were getting food and drink that met their needs. We saw many examples of excellent care, finding that 45 hospitals were meeting both of these standards. At 35 hospitals we made suggestions for improvement, although essential standards were being met. However, we found 11 hospitals that were not meeting one of the two essential standards, and in nine cases neither of the essential standards was met.
• Another of the outcomes says people can expect to be safeguarded from abuse or the risk of abuse and have their human rights respected and upheld. Our figures show that independent hospitals and clinics met this outcome most readily. The abuse uncovered at Winterbourne View hospital, however, highlights the failure of the system to protect people with learning disabilities, challenging behaviour and mental health problems. The safeguarding of the most vulnerable remains of utmost priority for providers, commissioners and regulators. In both the NHS and adult social care, failure to comply with this outcome was one of the three most common reasons we issued warning notices in response to major concerns.
• The reporting of patient safety incidents or near misses is an important way in which organisations can learn from mistakes and support ongoing improvement. In 2010/11 there were 1.25 million incidents reported, an increase on the 1.19 million reported the previous year. This continued the year-on-year increase.
• The NHS continues to make good progress in infection control. In 2010/11 there was a 22 per cent reduction in MRSA cases compared to the previous year, and a 15 per cent reduction in C. difficile infections.
• The NHS inpatient survey provides valuable information about inpatients’ perceptions of cleanliness:
  • There have been year-on-year improvements in perceptions of hospital cleanliness. In 2010, two-thirds of inpatients said their hospital room or ward was “very clean”.
  • In 2010, the proportion of patients reporting that, as far as they knew, doctors “always” washed their hands between touching patients rose to 78 per cent. Ninety-six per cent of patients had seen promotional information asking patients and visitors to wash their hands or use hand-wash gels.
• There were once again significant improvements in efforts to eliminate mixed-sex accommodation in NHS hospitals. More respondents to the 2010 patient survey reported not having to share sleeping areas or toilet and washing facilities with patients of the opposite sex than was the case in 2009.
• The results of the 2011 community mental health services survey were very similar to those the previous year: overall, 29 per cent of respondents rated the care they had received as excellent, 30 per cent as very good and 20 per cent as good. The vast majority of participants said they were listened to and had trust in their health and social care workers. However, the findings show there is room for improvement, especially in involving people more in some aspects of their care.

Case study
Nurse rounding scheme

In March 2011, wards for older people at the Royal Free Hampstead NHS Trust were inspected as part of a national programme. Our inspectors found the services did not meet two outcomes: respecting and involving patients, and meeting their nutritional needs.

In response, the wards instigated a new ‘nurse rounding’ scheme – hourly checks on all patients with specific needs such as positioning or pain relief. The nurses record their checks in the patients’ records, and this has resulted in patients using the call bell much less than previously.

A new system was put in place to organise meal times. Patients now have a designated member of staff to deliver their food, discuss their meal beforehand and monitor what food has been eaten. A red tray system indicates where help with eating is needed, and trained volunteers are brought in to assist patients where necessary.

A follow-up inspection in July 2011 found significant improvements. Patients were more positive about their care. They had a choice of food and access to food and drinks 24 hours a day. During mealtimes, staff were making sure patients were comfortable and checking that they had sufficient to eat and drink.

Caroline Cahill, sister on one of the wards inspected, said: “The whole environment of the ward has changed. It is much calmer and more organised. Before, many things – like mealtimes, making sure patients could reach their call bells and most importantly that they understand the plans for their care – were seen as the concern only of the nurses. Now everyone makes it their business.”

Deborah Sanders, nurse director, said the inspection acted as a trigger for a general review of how the Royal Free checks its compliance with CQC standards and had a much wider impact. “It really helped us think very differently about how we make sure our patients are receiving the care they should. We ensured that everyone we needed to help make the required changes was involved in the detail and at every stage. We took a truly multi-system approach.”