Some of the poorest quality services were struggling to make any improvement

Among the majority of care providers that are mostly good, some had improved from being rated as inadequate and requires improvement, including some of those in special measures. But there remains a small minority of underperforming services that have continually failed to improve.

While 6% of GP practices were rated inadequate or requires improvement at 31 March 2020, there are 46 practices (1% of all practices) that have never been rated better than that. These practices equate to just under 294,000 people on practice lists who have never had access to care rated as good. In addition, there were 3% of practices (196) that have had one rating of good or outstanding but at 31 March had fallen back to inadequate or requires improvement – and these practices account for a total patient list size of more than 1.8 million people.

In adult social care, 3% of care homes (512 homes, covering nursing and residential homes and accounting for just under 23,000 beds) have never been rated better than requires improvement, and a further 8% (1,216) have had one good or outstanding rating but are currently rated as inadequate or requires improvement (accounting for just over 42,000 beds). For community social care, 3% (212, providing services to more than 9,000 people) have never been rated better than requires improvement, and a further 5% (393, providing services to more than 18,000 people) have had one good or outstanding rating before falling back to inadequate or requires improvement by 31 March 2020.

The special measures regime for NHS trusts exists to give them extra help and support to improve after they have been rated as inadequate. There have been 37 NHS trusts in special measures since they were introduced in 2013 – roughly one in six of the total number of trusts across those seven years. The support offered as part of special measures has largely been successful – of the 37 trusts, 32 have improved enough to exit special measures.

However, four of them deteriorated again and were put back into special measures at a subsequent date (Northern Lincolnshire and Goole NHS Foundation Trust, United Lincolnshire Hospitals NHS Trust, The Queen Elizabeth Hospital King's Lynn NHS Foundation Trust, and Norfolk and Suffolk NHS Foundation Trust). As at 31 March 2020, there were nine trusts in special measures overall.

The time it has taken to turn around trusts has been longer than expected – the average time between entering and exiting special measures has been 27 months, and the longest time so far for a trust to be in special measures has been 57 months. It is clear that some of the problems holding back trusts are deeply embedded and that the fundamental changes and external support that are needed take longer than originally envisaged to bring about improvement.

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There were significant gaps in access to good quality care

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Adult social care remained very fragile