You are here

Our Market Report

Categories:
  • Public

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.

View the map in full screen

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.

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.

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
 

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.

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.

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.

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.

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).

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 or use our data on Google Drive

 

 

Last updated:
29 May 2017

 


Help us improve this page