Care that is harder to plan for was of poorer quality

While most care is rated as good across different settings, there were some areas that remained a great cause for concern. These were typically in those areas where care was harder to plan for – where providers cannot by themselves control the flow of patients to their services and, as a result, they have to plan for an unpredictable level of care.

For example, the quality of urgent and emergency care in NHS acute hospitals had barely changed compared with the previous year, and there was still too much that needed to improve. Seven per cent of these services were rated as inadequate at 31 March 2020, and 44% were rated as requires improvement.

The quality of maternity services has barely changed, with at least one in four ‘maternity’ core services rated as requires improvement overall at 31 March 2020. Looking across both ‘maternity’ and the older ‘maternity and gynaecology’ services, 41% were rated as requires improvement for safety and 1% were rated as inadequate for safety. We continued to see some services where staff did not have the right skills or knowledge, where poor working relationships between obstetricians, midwives and neonatologists posed a barrier to safe care, and where there was limited oversight of risk and a lack of investigation and learning when things go wrong.

And while, in NHS and independent mental health services, there was some slight improvement in the quality of acute wards for people of working age, 6% were still rated as inadequate and 36% as requires improvement. In addition, specialist community services for children and young people got worse, with 6% rated as inadequate and 27% rated as requires improvement.

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Care services needed to do more to join up

Quality overall before the pandemic