Welcome to the first of our quarterly Market Reports. In these reports, we will publish information on the results of our day-to-day inspection work. This information can help you find out more about the quality and safety of different types of care across England.
The graphs, charts, data and commentary we are publishing includes:
- The number of services we have inspected in each of the sectors we regulate
- Where these inspections took place shown on maps of England
- What the inspections found - whether each service was meeting the national standards we checked
- How well each of the national standards were being met across each sector.
We are also making the data available to use online or download so you can use it for yourself.
In each of our reports, we will focus on a particular type of care. In this first report, we focus on maternity services.
Our inspection findings
The graph above shows the results of our inspections across all sectors as at the end of March 2012. It is broken down into those where:
- the national standards were being met (shown as green)
- at least one standard was not being met and we required an action plan from the provider (shown as grey)
- there were serious concerns and we took urgent action (shown as red).
Where our inspections were
The map above shows the services where we had completed inspections and their status at the end of March 2012. The colour of the circles corresponds to the categories in the pie chart on the left.
If you click on any of the circles, you will see information on the service in question including a link to find out about their current status.
The sectors we regulate
| Providers | Locations | |
|---|---|---|
| NHS | 291 | 2,396 |
| Independent healthcare | 1,227 | 2,764 |
| Adult social care | 12,429 | 25,008 |
| Primary dental care | 8,112 | 10,130 |
| Independent ambulance | 243 | 323 |
The table above shows the numbers of organisations registered with us to carry on care services ('providers') on 31 March 2012. It also shows the number of hospitals, clinics, care homes, agencies, surgeries or other services ('locations') where they operate these services.
Many of these organisations carry on services in more than one sector so for the purposes of this chart, we have categorised them by their main activity.
Sector by sector
In the section below, you can see information about how well each sector is meeting the national standards we inspect.
By clicking into each section, you can read our analysis and commentary of the data we have published for each sector. This includes:
- Details of the proportion of services that were meeting the national standards
- Graphs showing the areas of care where we found the most concerns
- Case studies that highlight the main issues we found.
NHS services
This section of Our Market Report relates to NHS services. Here, we look at how well these services were meeting each of the national standards we inspect. The data below includes all our inspections under our new system of regulation up until the end of March 2012.
The pie chart below shows the proportion of NHS services we inspected that were meeting the national standards.
As you can see, the results of our inspections show that:
- 77 per cent of services inspected were meeting all the national standards.
- 21 per cent were not meeting at least one standard. In these cases, we required an action plan from the organisation telling us how they were going to improve.
- In one per cent of cases, there were serious concerns that led us to take more urgent action.
Where the inspections took place
We carried out inspections of NHS services across England. On the map below, you can see each of the services we inspected. Those found to be meeting all the standards we checked show as green circles, those found to be not meeting standards and where we required an action plan are grey circles and the red circles represent services where there were serious concerns that led us to take urgent action.
You can click on any of the circles to find out more about the service involved and their latest position.
In-depth findings
Findings for each standard
The chart below shows the percentage of NHS hospitals found to be meeting and not meeting each of the national standards we inspect. The green bar represents those meeting the standard and the grey one those that are not.
If you hover over each bar, you can see the percentages and the full text of each outcome.
Levels of concern
The chart below shows the percentages of both moderate and major concerns for each of the standards where we found compliance rates below 90 per cent.
As you can see from the table, the outcome with the highest level of major concerns was staffing.
Behind the numbers: Staffing in the NHS
Our inspectors found that staffing is emerging as a key driving factor around non-compliance in the NHS.
A lack of availability of temporary staff as well as vacancies in qualified staff often led to compromises around the care and welfare of patients and support for staff including training and supervision.
Sometimes, formal staffing assessments had not been carried out or implemented.
Continuity of care was also affected, leading to a poorer patient experience. Typical of this was a mental health setting, where escorted leave could not always be accommodated – so a lack of staff was directly impacting on the ability to provide a range of services that can support patients and improve their care and welfare.
Case study: Cambridge Community Services NHS Trust
In April 2010, Cambridgeshire Community Services NHS Trust became the first specialist NHS community trust created in England.
At the time, the trust acknowledged it was not meeting the required staffing levels and this was affecting its:
- Special care baby unit
- Health visiting service
- District nursing service.
By November 2011, the trust had confirmed that they had secured staffing in the special care baby unit and the health visiting service. However, it was still not meeting the relevant standard in the district nursing service across Cambridgeshire.
The key reasons for this were due to staff shortages:
- The trust was only just able to meet the demand for staff to respond to urgent requests for visits
- Staff were being frequently moved around to cover leave and sickness absence
- Some patients said they were receiving poor continuity of care due to staff changes.
Action we took
We asked for an action plan from the trust to tell us how they were going to tackle this. They sent us a detailed plan which outlines how they will achieve a stable district nursing service within Cambridgeshire.
They have also demonstrated to us in meetings that they have taken clear and robust action to understand and manage the risks to the service on a daily and ongoing basis.
The action plan will involve a large amount of work to change the service and the trust is aiming to meet the standard by the end of June 2012.
We will follow up to ensure the necessary action has been taken.
Independent healthcare
This section of Our Market Report relates to independent healthcare services. Here, we look at how well these services were meeting each of the national standards we inspect. The data below includes all our inspections under our new system of regulation up until the end of March 2012.
The pie chart below shows the proportion of independent healthcare services we inspected that were meeting the national standards.
As you can see, the results of our inspections show that:
- 82 per cent of services inspected were meeting all the national standards.
- 18 per cent were not meeting at least one standard. In these cases, we required an action plan from the organisation telling us how they were going to improve.
- In one per cent of cases, there were serious concerns that led us to take more urgent action (Note: percentages do not add up to 100 due to rounding).
Where the inspections took place
We carried out inspections of independent healthcare services across England. On the map below, you can see each of the independent hospitals, clinics and other services we inspected. Those found to be meeting all the standards we checked show as green circles, those found to be not meeting standards and where we required an action plan are grey circles and the red circles represent services where there were serious concerns that led us to take urgent action.
You can click on any of the circles to find out more about the service involved and their latest position.
In-depth findings
Findings for each standard
The chart below shows the number of independent hospitals found to be meeting and not meeting each of the national standards we inspect. Compliance is represented by the green bar and non-compliance by the grey one.
If you hover over each bar, you can see the exact numbers and the full text of each outcome.
Levels of concern
The chart above shows the percentages of both moderate and major concerns for each of the standards where we found compliance rates below 90 per cent.
As you can see from the table, the outcome with the highest level of major concerns was records management.
Behind the numbers: Records management
The management of records appears as an area of greater non-compliance in a number of sectors; for independent hospitals it was the area with the most overall major and moderate concerns.
In our inspections where it was an issue, we found a range of problems: records sometimes incomplete or not up-to-date, putting people at risk of receiving unsafe or inappropriate care; records being accurate but not kept securely or confidentially; records not clearly showing that people were involved in their treatment or that risks to their safety had been identified and managed.
There were sometimes problems of inaccessibility of records – for example, the operation records for a consultant being stored in a folder in the treatment room, which did not comply with national guidance and created a greater risk of the records getting lost or accessed inappropriately.
Case study: The Retreat, York
This service, an independent hospital providing care and treatment for people detained under the Mental Health Act, had moved to storing and recording care documentation in computerised records, which were supplemented by paper records.
There were inconsistencies in which records were stored on computer and which in paper records for each unit. We found:
- Some of the paper records were chaotic and had very old records with recent entries.
- Nurses and support workers had different levels of competency in navigating the records.
- Some staff struggled to identify the care needs from the records.
One of the managers, however, was able to use the computer system very well and was able to instruct inspectors in how to navigate the records.
The computerised records did not have a method for patients to record their consent and their views. The senior managers explained these should be printed off and stored in the paper records.
This was not consistently occurring on the wards and some of the printed records we saw which had been printed off had not been signed by anyone.
Action we took
We asked for an action plan to tell us how the hospital would improve its maintenance of patients' records and how it would make sure that all staff are able to access the appropriate records to carry out their work safely.
We will re-inspect the hospital shortly.
Adult social care
This section of Our Market Report relates to adult social care services. Here, we look at how well these services were meeting each of the national standards we inspect. The data below includes all our inspections under our new system of regulation up until the end of March 2012 and is broken down into the types of service - care homes, nursing homes and home care agencies.
The social care market has seen a trend in recent years towards services that enable people to continue living in their own homes and communities. This has meant a reduction in the number of residential care homes and an increase in home care agencies.
The timeline above shows how the numbers of residential care homes, nursing homes and home care agencies have changed over the past seven years.
Consolidation of the sector may lead to a larger number of bigger care homes in the future. We will continue to monitor these trends.
The pie chart below shows the proportion of adult social care services we inspected that were meeting the national standards.
As you can see, the results of our inspections show that:
- 72 per cent of services inspected were meeting all the national standards.
- 27 per cent were not meeting at least one standard. In these cases, we required an action plan from the organisation telling us how they were going to improve.
- In one per cent of cases, there were serious concerns that led us to take more urgent action.
Where the inspections took place
We carried out inspections of adult social care services across England. On the map below, you can see each of the services we inspected. Those found to be meeting all standards inspected show as green circles, those found not to be meeting standards and where an action plan was required are grey circles and the red circles represent services where there were serious concerns that led us to take urgent action.
You can click on any of the circles to find out more about the service involved and their latest position.
In-depth findings
Findings for each standard
The charts below shows the number of adult social care locations found to be meeting (represented by the green bar) and not meeting (grey bar) each of the national standards we inspect.
If you hover over each bar, you can see the exact numbers and the full text of each outcome.
Residential care homes
Nursing homes
Home care agencies
Levels of concern
The charts below show the percentages of both moderate and major concerns for each of the standards where we found compliance rates below 90 per cent for each of the three service types.
As you can see from the charts, the outcome with the highest level of major concerns was management of medicines.
Residential care homes
Nursing homes
Home care agencies
Behind the numbers: Management of medicines
Medicines management was clearly the area of most concern across all the different types of social care service. In this sector, we are starting to see that more complex drug treatments and significant growth in co-morbidity are putting an increasing demand on social care environments.
One of the most common problems we found was around the administration of medicines not being correctly recorded, which reflects another of the standards with lower compliance.
Other problems included storage of medicines not being monitored in line with the provider's policy and staff not always correctly following the policies and procedures that are in place. Concerns about medicines training were raised by some staff.
Case study: Hugh Myddelton House, Southgate
At Hugh Myddelton House, a nursing home in North London, we found problems with a number of the medicines records we reviewed. People were missing doses of medicines, and poor records meant we could not tell whether some medicines had been given.
It was clear that the system for ordering medicines was not effective. During March, 12 prescribed medicines had run out, so people had missed medicines, including pain relief, for up to five days.
One person should have taken an anti-coagulant medicine every day to reduce the risk of a stroke but the medicines chart showed that this had not been administered for more than two weeks; however, staff had been waiting for advice from the GP or hospital.
Another person had been prescribed a controlled drug for pain relief to be given at 8am. On the day of our visit, we saw that staff did not give this pain-relieving medicine until 11.45am. Staff told us that this was often given late because there was only one nurse on duty on this floor, so they had to wait for a second nurse to witness this medicine being given.
One resident should have had an anti-emetic patch, prescribed for use every 72 hours, but medicine charts showed it had been applied on four consecutive days. Some people had been prescribed sedatives to be used when they became agitated, but there was no guidance for staff on how these medicines should be used or records of why they were needed.
Staff did not always keep notes on people's records when medicines were stopped or changed, and medicines that were no longer needed were not being disposed off in a timely manner.
We formally warned the provider, Barchester Healthcare Homes Limited, that it was failing to comply with the regulations. We issued a warning notice which made it clear that if the company failed to comply by 23 April, we would consider further action.
The local council suspended further admissions to the home, working closely with our inspectors under safeguarding procedures to ensure that people were not at risk of further harm.
Barchester Healthcare provided us with an action plan telling us how the care home would make sure that people would always be given the correct dose of medicine at the correct time, and that this would be correctly recorded.
Inspectors have been back to the home to check and will decide whether any further action is required. A full inspection report will be published soon.
Primary dental care
This section of Our Market Report relates to primary dental care services. Here, we look at how well these services were meeting each of the national standards we inspect. The data below includes all our inspections under our new system of regulation up until the end of March 2012.
The pie chart on the right shows the proportion of NHS services we inspected that were meeting the national standards.
As you can see, the results of our inspections show that:
- 88 per cent of services inspected were meeting all the national standards.
- 12 per cent were not meeting at least one standard. In these cases, we required an action plan from the organisation telling us how they were going to improve.
- We did not find serious concerns that led us to take more urgent action.
Where the inspections took place
We carried out inspections of dental services across England. On the map below, you can see each of the services we inspected. Those found to be meeting all standards show as green circles while those found not to be meeting one or more standards appear as grey circles.
You can click on any of the circles to find out more about the service involved and their latest position.
In-depth findings
As the dental care sector only came under the new regulatory system last year, it is too early to compare the compliance rates of all the standards.
The chart below, however, shows the compliance rates for the standards where we have focused our first inspections of this sector.
If you hover over each bar, you can see the exact numbers and the full text of each outcome.
Independent ambulance services
At the end of March this year, we had inspected and published reports on 19 of the 323 services registered with us in this sector.
As this number is low both in absolute terms and as a proportion of the sector, we will wait until a later issue to report on our findings.
Focus on maternity services
Since our registration of NHS trusts in 2010, we have identified and responded to concerns in maternity services in a number of trusts. The concerns shared a number of common elements including staffing levels, quality of clinical care, and learning from incidents.
We looked at the issue of NHS maternity services to help our inspection teams understand what issues might affect a trust's compliance with the national standards:
- Staffing
- Experience of women using services
- Clinical outcomes and contextual risk.
Challenges facing maternity services
Maternity services in England face a number of challenges that can compromise the safety of mothers and babies. The number of babies born in England has increased significantly during the past decade. The 2011 NHS survey of maternity patients suggested that poor care of some kind was experienced by between four and eight per cent of women.
There are three main challenges facing maternity services:
- Rising birth rate
- Births are increasingly complex
- Midwife staffing levels
What compliance tells us
There are 141 NHS trusts that provide maternity and midwifery services. We looked at those trusts that were not meeting at least one essential standard on 31 March 2012, and where we had asked for an action plan.
The most common concerns related to staffing levels, support for staff, and care and welfare of patients.
Example issues
We have selected some extracts from our inspection reports which typify the kinds of issues we have found in maternity and midwifery services. Click on the titles below to read the extracts.
Pinderfields General Hospital, Mid Yorkshire Hospitals NHS Trust
Outcome: 13 (staffing)
"The antenatal/postnatal ward has four beds allocated as the triage area. Midwives we spoke with were concerned that there is sometimes extra pressure on them when they have to staff the triage area and are called to support the labour ward.
"There is no system of monitoring the daily redeployment of staff within the hospital; if staff are called to other ward areas, the ward they were originally allocated to can be left short-staffed. We observed that midwives had been called to other areas on the day we inspected, but there was no record of this. For this to be appropriately managed, a record should be kept when staff are redeployed.
"Staff told us that there are times when only one midwife is left on the ward area. This was particularly apparent during night shifts. Some staff told us some women can go for long periods without being seen.
"We checked records and saw an instance where one prescription chart showed that IV antibiotics were given later than required. Staff said this was due to staff shortages, as midwives from the antenatal/postnatal ward were called away to other ward areas in maternity to assist."
Action we took
We asked for an action plan to tell us how the hospital would tackle these issues. In our follow-up inspection report in April 2012, we noted that the trust had implemented a risk assessment form for moving staff between clinical areas. These are completed before any moves can take place, and completing them ensures that the staff member is not leaving a particular ward area short-staffed. We saw evidence of how this was communicated and used.
The trust had also implemented a change in the way the staff work across maternity services, by rotating and working between Pinderfields and Dewsbury and District Hospital.
A new twilight shift will also give extra cover during shift handovers, so there are more staff at critical times such as mealtimes. We judged that the hospital was now meeting Outcome 13.
Castle Hill Hospital, Hull and East Yorkshire Hospitals NHS Trust
Outcome: 13 (staffing)
"We found that the trust's vacancy rate for qualified nurses and both midwifery and health visiting staff was greater than that of other trusts. Ongoing vacancies could have the potential to add strain to the existing staff in covering the service and does not assist in fully meeting people's needs…
"…The trust provided us with additional information following the visit regarding vacancy levels and staffing across maternity services. They told us that there were a total of 199 midwife posts, with 11.46 vacancies. They also told us that in the two weeks following our visit the centre would have to be closed on four separate occasions due to a lack of staff. On two occasions, people had to be transferred to Hull Royal Infirmary when there were not enough staff at the centre to ensure meeting their needs.
"When we spoke to the staff on the ward, they told us about the times when the birthing centre would have to be closed for a period of time. This had the potential to cause great distress and did not promote patient choice; couples had made a positive choice to have their baby at the centre, but staffing levels had prevented this."
Action we took
We asked for an action plan to tell us how the hospital would tackle these issues. In our follow-up inspection report in March 2012, we noted that the birthing centre had been closed permanently and services transferred to Hull Royal Infirmary. We inspected three wards at Castle Hill to see if compliance was now being maintained. The three ward managers we spoke with all confirmed that staffing rotas were being maintained, and arrangements for ensuring continuity were being met.
We spoke to several nurses, junior doctors and cleaners, and a pharmacist. Most felt that recent structural changes in management had led to issues with maintaining staffing levels during the reorganisation. However, they all felt the situation had improved and were more confident that adequate staffing could be maintained. We judged that the hospital was now meeting Outcome 13.
Queen's Hospital, Barking, Havering and Redbridge University Hospitals NHS Trust
Outcome: 4 (care and welfare of people using the service)
"Staff on the postnatal ward recognised there had been an increase in staffing but overall did not feel there had been much of an improvement. The midwives considered this was mainly because of the number of women on the ward classed as 'high risk' or who had social needs.
"It was also the perception of staff that the discharge system did not work effectively as there were not enough paediatricians to make sure the women were discharged promptly. One midwife told us, 'To give the required level of care it is really difficult and the sheer activity has gone through the roof. We don't stop'. Another said, 'Women go into the discharge lounge too soon if we have an urgency for beds'."
Action we took
We issued a number of warning notices to Barking, Havering and Redbridge University Hospitals trust in 2011. Despite these, we continued to identify concerns at the trust and we continued to receive information and reports of poor quality care from patients and the public.
We took the decision to carry out a formal investigation of the trust, including maternity services at Queen's Hospital. We published our investigation report on 27 October 2011 and made 16 key recommendations to the trust. We have just published a progress report report which shows that some improvements have been, although there is still more to do.
Key indicators
In line with our general findings across health and social care, staffing issues were the biggest area of concern. We have looked at indicators including:
- The ratio of midwives to births
- The midwife vacancy rate
- The ratio of supervisors to midwives.
This highlighted a number of regional variations that may impact on the quality of maternity services.
Ratio of midwives to births
For the calendar year 2011, we found that:
- 26 trusts (18 per cent) had a ratio of midwives to births higher than average
- 94 (67 per cent) had a ratio similar to average
- 21 (15 per cent) had a ratio lower than average.
Rising birth rate
The number of live births in England rose from 563,744 in 2001 to 687,007 in 2010.
Analysing by region, we found:
- The South West had the highest proportion of trusts with a higher than average ratio of midwives to births (31 per cent), followed by the North West (29 per cent).
- The South East had the highest proportion of trusts with a lower than average ratio (33 per cent), followed by London (23 per cent).
- Yorkshire and Humber and the North East were the only two regions where all trusts had a ratio that was similar to, or higher than, average.
The chart below shows the percentage of trusts in each strategic health authority that had a lower than average, similar to average and higher than average ratio of midwives to births.
Midwife vacancy rate
The most recent official figures for NHS midwife vacancies were published in 2010. At the end of March that year, there had been a fall in long-term vacancy rates across all major staff groups except midwives and GPs.
The NHS Information Centre noted that long term vacancy rates for midwives had steadily increased in recent years.
Staffing levels
Although births in England increased by over 21 per cent between 2001 and 2010, the number of midwives only increased by around 15 per cent, from 18,048 to 20,790.
The official figures show that in March 2010 the overall vacancy rate for midwives in England was 2.7 per cent while the overall long-term vacancy rate (those remaining unfilled for three months or longer) was 1.2 per cent.
Official NHS vacancy statistics were not published in 2011, as the collections are being reviewed. However, the Royal College of Midwives (RCM) conducts an annual survey of heads of midwifery services, and has used the 2011 responses to produce its own figures for midwifery vacancies.
The RCM's figures for midwifery vacancies are traditionally higher than official NHS vacancy figures. Based on its survey responses, the RCM found there to be an overall midwife vacancy rate in July 2011 of 4.8 per cent across England and a long-term vacancy rate of 3.2 per cent across England.
Ratio of supervisors to midwives
The supervision of midwives is a statutory function, and standards are set by the Nursing and Midwifery Council (NMC).
In England, there are ten local supervising authorities (LSAs) for midwives, currently located in the strategic health authorities. They are responsible for ensuring an effective framework for supporting and monitoring the quality of supervision of midwives and midwifery at local level.
More complex births
Over the last twenty years, the number of live births in England and Wales to women aged 40 and over has nearly trebled from 9,717 in 1990 to 27,731 in 2010.
Each midwife is required to have a named supervisor, and the LSA should ensure that support, advice and guidance are available for midwives 24-hours a day to promote the safety of women and babies.
The NMC standard says that the ratio of supervisors to midwives should reflect local need and circumstances, but will not normally exceed 15 midwives for every one supervisor.
Figures show that London is the only region that has consistently failed to meet the required standard, and the only region where the standard was not met in 2010/11.
However, the NMC has said: "Although nine of the ten LSAs in England meet the ratio of 1:15 or less, it is clearly reflected in individual LSA annual reports to the NMC that many trusts continue to experience challenges in the recruitment and retention of sufficient new supervisors of midwives to replace those retiring or resigning."
About our data
In this report, you can find a wealth of information about our inspections since the start of our new regulatory system. Here we explain what time periods it covers, what the different measures mean and how you can use the data.
What time period is covered by the data?
The information we have published relates to all locations that we had inspected from the start of the new regulatory system up to 31 March 2012.
Therefore the information is a snapshot of compliance with the national standards as at that date.
Where a location had been inspected more than once (and the inspection report published by 31 March 2012), the compliance status is that of the most recent inspection.
The new regulatory system had different start dates in each sector. In the NHS, it applied from April 2010; in adult social care and independent healthcare, from October 2010; and for dental care and independent ambulance providers, from April 2011.
In total, we had inspected and published reports on14,060 locations as at 31 March 2012.
Overall findings
Overall, across all sectors on 31 March 2012, the majority of services – just under three-quarters (73 per cent) – were meeting all the national standards we checked.
In a number of cases, providers used innovative practices in meeting the standards.
In a quarter of cases (26 per cent, or 3,617 services) on that date, at least one standard was not being met. We required an action plan from the provider to tell us how they intended to address the problem.
The vast majority of providers worked positively with CQC to make sure they were taking all the necessary steps to improve.
On 31 March 2012, there were 130 services (one per cent of cases) where serious concerns meant we had to use our powers on a more urgent basis to protect people from harm or hold the provider to account.
The same areas of poor performance were apparent across both health and adult social care sectors:
- Medicines management
- Care and welfare of people
- Staffing and supporting staff
- Record keeping.
Similarly, the outcomes with the best performance tended to be the same across the sectors:
- Cooperating with other providers
- Handling of complaints
- Safety, availability and suitability of equipment
We asked our compliance managers and quality and risk managers across England to give us their view of where they saw the most problems emerging. Their responses reflected many of the issues highlighted above.
Of all the responses, the most common concerns were:
- Staffing levels (20 per cent of managers mentioned this as an issue)
- Staff training and knowledge (14 per cent)
- Medicines management (13 per cent)
- Poor management or support for management (11 per cent)
- Protecting people from abuse or the risk of abuse (9 per cent)
- Overall governance and quality assurance issues (9 per cent)
- Premises and environments (8 per cent).
Behind the numbers: Our expert's view
Our National Pharmacy Manager, Brian Brown, explains some of the main issues across both health and social care in relation to the failure to provide safe management of medicines.
Arrangements for people to look after their own medicines
Although services are usually able to show that they have a policy and procedure available to support this, this is often not translated into practice.
Examples include people taking medicines when the staff supporting them are not aware that they are prescribed that medicine; people having medicines left with them when they don't understand what the medicine is for or when they are supposed to take it; and staff making an assumption that the person is looking after their own medicines.
Poor practice in relation to medicines prescribed 'to be taken when required'
There is often a lack of a clear plan to indicate how the decision to administer these medicines is to be made or what the desired/expected outcome should be.
We also find that a person may be prescribed several similar medicines and there is no clear direction to indicate how to decide which of the medicines is to be administered and in what circumstances.
There are also occasions when this may lead to non-compliance with the 'care and welfare' standard (outcome 4). This is particularly relevant where care is being provided to people who may have a significant cognitive impairment.
Incomplete records of medicine administration, accompanied by no supporting record to indicate why a particular dose of a medicine had not been administered
There are occasions when this may lead to noncompliance with the 'records' standard (outcome 21) and 'care and welfare' (outcome 4).
This is also linked to times when medicines are not available to be administered. This may happen either when a supply of the medicine has run out and not been replaced, or when an acute prescription is written and then supplies are not sought in a timely manner, or where a person is admitted to a service and there are delays in obtaining their prescribed medicines before administration can commence.
Other areas
We have found include the poor provision of appropriate storage facilities. This may relate to either the lack of suitable arrangements to keep medicines secure, or the lack of provision to store medicines within the correct temperature range.
Compliance status
When we inspect, we look at a selection of the 16 national standards. In the graphs and maps in this report, you will see we have classified services as being:
- Compliant - this means they are meeting all the standards we inspected.
- Non-compliant - this means at least one of the standards we inspected was not being met and we required an action plan telling us how the provider would improve.
- Enforcement action - this means at least one of the standards we inspected was not being met and we are used our more urgent powers to protect people from harm or hold the provider to account.
We have also included graphs showing the standards with the most moderate or major concerns.
These levels of concern relate to the impact that a failure to meet one of the national standards has on the people using the service.
Using the data
As well as publishing the graphs, maps and commentary contained on these pages, we have also made the data available online.
This means you can download a spreadsheet of all the data or simply use it online to create your own analysis.
The graphs in this report were built using Google technology so you can download the data from there.
Download the report
You can also download our data from, or use it with, Google Drive.
Take a look at our Market Report infographic or download it below.
You can order our print publications online