The NHS is standing on a “burning platform” based on a care model that is no longer capable of meeting modern needs, according to Britain’s most senior hospital inspectors.
A three-year investigation by the Care Quality Commission has concluded that patients are at increasing risk in acute treatment centres and that the scale of the challenge facing hospitals is unprecedented.
Professor Sir Mike Richards (pictured), the most senior independent inspector, warns the service is not fit to serve the public and that radical changes are necessary to improve safety across the country, with four out of five hospitals in need of improvement.
He cites overcrowding, long delays for patients with life-threatening conditions, poor control of infections and funding among the causes of the crisis. However, apart from some stop-gap relief in the Budget, Government policy looks like continuing to move toward wholesale cuts.
The CQC findings come at a time of mounting public fears for the future of the NHS.
It is one of the most damning reports of any since of the inception of the National Health Service. In short, it says patients’ “safety”, whether they stand to get worse or die rather than recover, could be at greater risk inside hospital than outside. After three years during which it investigated every hospital – giving it a “baseline on quality that is unique in the world” – the CQC has concluded that: “The model of acute care that worked well when the NHS was established is no longer capable of delivering the care today’s population needs.”
Professor Richards is blunt in his introduction to the report: “The NHS stands on a burning platform. The need for change is clear, but finding the resources and energy to deliver change while simultaneously providing safe patient care can seem near impossible. Just a single acute, non-specialist centre came out with top marks for safety, with four out of five hospitals and trusts identified as in need of improvement. Faults and flaws ranged from overcrowding to fatal delays in treatment, as well as one of the growling hospital menaces, the failure to treat and contain infection. Dangers to patients, were a “real concern,” he added.
He praises the study for “giving us a detailed understanding of the quality of care across England, not only at an overall trust level, but also at an individual core service level”. In spite of the ubiquitous problems of “resources” – cuts to you, me the Treasury and Jeremy Hunt – this spread of information has resulted better targets and better practice among the worst and even some of these best hospitals (some of which are criticised for being self-satisfied about comparative good records rather than addressing other existing faults).
But the report was only made public a little over a week ago with virtually no coverage except on the BBC and in the Daily Telegraph. So it’s early days. Yet that has not stopped public perception seeping into reality. According to a recent poll for Ipsos Mori a growing group number of Britons think the NHS is getting worse and fear for its future. Of those polled 57% believe the NHS’s ability to deliver the care and services it is expected to provide has worsened over the past six months. One in four said it had got “much worse” while just 8% said it had got better. The over-75s were the only group who thought the NHS would improve (41%), while Tories were less pessimistic (50%) than Labour voters (61%). A separate Ipsos Mori international study found that Britons are more pessimistic about their healthcare system than people in 22 other countries. Almost half (47%) of Britons believe the healthcare they and their families will be be able to access will get worse in coming years.
Prof Richards and his CQC team appear to mirror this in their findings. They end on a positive note: “There is no doubt that compassion is alive and well. Caring is the most highly rated of the five key questions in acute, non specialist hospitals and, overwhelmingly we see staff behaving in a caring way, which is supported by what we hear from patients.” But they say there are “blind spots” throughout the service.
Facing steadily increasing demand for services, at a time when the CQC says they are expected to make “unprecedented efficiency savings”, hospitals are also facing an unprecedented demand for urgent and affordable emergency services. Most will scrape through. In others there will be tragedy, only a small amount we may hear of in fragmented and seemingly unrelated narrative. A constant will be Government pressure for cuts.
The NHS has been told to find £22 billion in “efficiency savings” by 2020. Health experts such as the Nuffield Trust and the King’s Fund say this will not be sufficient to both meet demand and bring services up to standard. Even with additional Government health care spending there will be a shortfall of £8 billion a year from next year. So how will the NHS cope? It won’t, is the easy answer. There simply won’t be enough money to go to round.
It is not, however, a simple choice between financial “efficiency” and high quality care, though it it is not possible to have one without the other. All hospitals, for example, cited patient safety as their top priority. But many did not translate this into quicker recovery, shorter lengths of stay intensive care units and basic hygiene to avoid hospital acquired infections, or links with social care services. Recruitment and retention of staff are continuing problems, with too much reliance on temporary and agency staff. Work-related stress, bullying and discrimination can also affect levels of patient safety and too many hospitals do not listen effectively to “the heroes of our reports”, frontline staff who never lose sight of the need for patient safety.
“Our reports are a start to putting this right,” predicts Prof Richards. Meanwhile, the burning platform of which he speaks may be just smouldering or about to blaze.