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Most people are receiving good care – but strong leadership and collaboration are crucial to facing challenges ahead

15 October 2015

The Care Quality Commission (CQC) today publishes its annual analysis of the quality of health and adult social care in England. This is the first time such a national assessment has been possible following CQC’s introduction of a tough, rigorous ratings system. Key findings include:

  • Despite increasingly challenging circumstances, the majority of services across health and social care have been rated as good, with some rated outstanding.
  • However, there is significant variation in quality - and safety continues to be the biggest concern across all the sectors that CQC regulates.
  • Strong leadership and collaboration is emerging as more crucial than ever to delivering good care.
  • Evidence increasingly shows that CQC’s work is leading to improvements in care.

The number of services rated as either good or outstanding by CQC suggests most people are receiving safe, effective care.

Although CQC has not finished inspecting all providers, the ratings published up until the end of May 2015 show more than 80% of GP practices are rated either good or outstanding; in adult social care, nearly six out of ten services are rated good or outstanding; and 38% of hospitals and trusts, including mental health, have been rated good or outstanding.

Our inspections have identified strong leadership as a crucial factor among those providers rated as either good or outstanding. More than nine out of 10 (94%) of the services we have rated as good or outstanding overall are also rated as good or outstanding for their leadership. Similarly over eight out of ten (84%) of the services we have rated as inadequate overall were rated inadequate for leadership.

Leadership – at all levels – is key not only to running a successful organisation, but in turning around a failing one; the ability to recognise a problem, coupled with the ability to change. Genuine engagement with staff is crucial, and there is a positive correlation between whether staff would recommend the NHS Trust that they are working for and CQC’s rating for that Trust.

Having the right numbers and mix of staff are also crucial to delivering excellent care. This means looking at staffing in a sophisticated way which is focused on the quality of care, patient safety and efficiency, rather than just crude numbers and ratios of one group of staff. The providers who are getting this right are practicing robust workforce planning informed by excellent data, alongside a willingness to collaborate with partners across the local health economy.

However, alongside these encouraging findings, there remains an unacceptable level of poor care, with 7% of providers of acute, primary medical and adult social care in England rated as inadequate.

Safety continues to be our biggest concern across all of the services we inspect. We have rated over one in 10 hospitals (13%) and a similar proportion of adult social care providers (10%) as inadequate for safety. In primary medical services, 6% of those we rated were inadequate for safety.

Our analysis highlights a range of factors affecting safety across all of the sectors. These include: a failure to adequately investigate and learn from incidents and errors so they don’t happen again, concerns around the adequacy of staffing numbers and staffing mix, failure to undertake safety checks and staff not being able to raise concerns.

In this year’s State of Care, we are able to demonstrate how CQC encourages improvement. The initial results from our re-inspections so far suggest that half of providers have been able to improve their ratings within six months in at least one of the five key questions. Where improvements are not made, we are increasingly likely to take enforcement action - in 7% of inspections in 2014/15, compared with 4% in 2013/14.

In our most recent annual cross-sector provider survey, almost three-quarters (73%) said that our inspection had helped to identify areas of improvement and over seven out of 10 providers (72%) said the inspection reports were useful.

Commenting on the findings, Chief Executive of the Care Quality Commission David Behan, said: "The health and social care sector is facing an unprecedented level of challenge – so it’s encouraging that our findings show that the majority of people are receiving good or outstanding care. We have found dedicated staff working hard to treat people with care, compassion and dignity.

"However, we have also found a wide variation in the quality of care people receive. Alongside good care we have seen examples of poor and unacceptable care and we rated 7% of care as inadequate. A key concern has been the safety of the care – a failure to learn when things go wrong, or not having the right number of staff in place with the right skills.

"Where people are not receiving the quality of care they deserve, we will demand action – and we are now able to demonstrate that half of services have improved following re-inspection. Some services may need further support to improve, and we will continue to work with partners to ensure this happens.

"The variation in care that we have observed is not just about the money. Good leaders are what make the difference - leaders who engage staff and people who use services and create a culture of continuous quality improvement. Leaders who have a broader vision than the delivery of care within their own organisations, but who work collaboratively with partners to innovate and transform services. What is very clear is that isolated working and incremental changes are not going to be enough to meet the challenges ahead.

"CQC’s role is to support innovation, share information that can help leaders to better understand the quality of care that their organisation provides and to benchmark against others and to celebrate great care and great leadership. It is also to highlight poor care and poor leadership where we find it, to demand improvement and to take action to ensure that people receive safe, high quality care.”

The challenges for the care sector as identified in the report are:

  • Building a collaborative culture, through good leadership, engaging with all staff to ensure they are bought into the vision and values and owning the quality of care they deliver.
  • Being open and transparent and learning from mistakes, ensuring the most accurate information is on hand to make good decisions and to understand what works (and what doesn’t), using opportunities to learn from the best.
  • Working with local and national partners to ensure that services have the right staff and skills in place to ensure that care is always safe.

- Ends -

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Last updated:
29 May 2017

Notes to editors

We plan to inspect all acute hospitals by the end of March 2016, with community, mental health and ambulance services by June 2016. We plan to inspect all adult social care services and primary care services by the end of September 2016.

Sector specific highlights and our challenge to the sector

Adult social care

  • By the end of 31 May 2015, we had rated 18% of residential care homes, 27% of nursing homes, 8% of domiciliary care services and 10% of other community services.
  • Our inspections so far showed that 59% of services overall were providing good or outstanding care.
  • The vast majority of services are caring, with 85% receiving a rating of good or outstanding. This is supported by high satisfaction rates of people who use adult social care services.
    • The re-inspections we have carried out so far have led to 40% of inadequate ratings changing to a higher rating. Twenty-eight per cent of requires improvement ratings have improved on re-inspection.
    • The sector is under pressure and there are issues of sustainability, due to increasing demand and costs.
    • Services must have a registered manager consistently in post, as this has a crucial influence on the quality of a service.
    • Recruitment and retention of staff, particularly of nurses and care support workers, remain a serious challenge.


  • Up until 31 May 2015, we have rated over 150 services which includes: acute hospitals, mental health trusts, ambulance and community trusts.
  • Of these, two (1%) were rated outstanding, 51 (34%) were good, 85 (57%) required improvement and 12 (8%) were rated inadequate The overall ratings in the sector show a lower proportion of good and outstanding hospital ratings (38%), compared to primary care and adult social care ratings.
  • Nationally, intensive/critical care offers the highest quality (68% were good or outstanding), while the strongest need for improvement is in medical care (34% were rated good or outstanding).
  • Urgent and emergency care has the joint highest proportion of outstanding ratings (4%) but also the second highest proportion of inadequate ratings (9%).
  • The acute sector reported 10% more serious incidents between 2013 and 2014.
  • There is a positive correlation between whether staff would recommend the NHS trust they are working for and CQC’s quality rating for that trust.
  • Of the eight NHS mental health trusts rated so far, four are good, three require improvement and one is inadequate.
  • Hospitals need to move the focus from developing individual, short-term quality initiatives to creating the right culture in which staff are able work with autonomy and confidence.
  • Patients must be able to complain with the confidence that they will be listened and they should be reassured that raising a complaint will not negatively impact on the standard of care they receive.

Primary care

  • Over four in five (85%) of the GP practices we have rated are good or outstanding. Almost one in nine (11%) of the GP practices we inspected required improvement. Four per cent of those we inspected were inadequate.
  • By 31 May 2015 we had inspected and rated 976 GP practices and out-of-hours services.
  • We remain concerned by the very poor practice we find in some practices through our inspections.
  • GP practices are generally well-led, with 85% of practices rated good or outstanding.
  • Ninety-six per cent of services were rated good or outstanding for caring.
  • GP practices deliver a better quality of care when sharing learning and providing joined-up care through multi-professional networks. Single handed practices are more likely to work in professional isolation, resulting in a lack of communication and engagement with staff and patients.
  • We encourage all healthcare professionals to avoid professional isolation and work with colleagues in and out of their practice.

About the Care Quality Commission

The Care Quality Commission (CQC) is the independent regulator of health and social care in England.

We make sure health and social care services provide people with safe, effective, compassionate, high-quality care and we encourage care services to improve.

We monitor, inspect and regulate services to make sure they meet fundamental standards of quality and safety and we publish what we find to help people choose care.