“Quality has improved overall, but there is still too much variation and some services have deteriorated.”
“Quality has improved overall, but there is still too much variation and some services have deteriorated.” That’s the conclusion of the annual State of Care Report 2016/17 by the Care Quality Commission. State of Care is the document which the CQC publishes to communicate its assessment of the quality of health and social care provision. Though its responsibility is to regulate provision of service provision across England the report has relevance for doctors in all four corners of the UK. Its unsurprising that news coverage of its publication left little to feel positive about. BBC responded with a headline conveying deep concern: “NHS future precarious, says regulator.” But could there be more to the State of Care Report beyond such headlines? Let’s go back to the source and consider the key messages from the CQC’s in their own words.
The findings can be summarised via its five key points:
1: Health and care services are at full stretch.
2: Care providers are under pressure and staff resilience is not inexhaustible.
3: The quality of care across England is mostly good.
4: Quality has improved overall, but there is too much variation and some services have deteriorated.
5: To put people first, there must be more local collaboration and joined-up care.
Healthcare professionals are acutely aware that the system is at full stretch with providers under pressure. Recognition that the quality of care is mostly good, in spite of the challenges, may surprise some and is encouraging. Acknowledgement that there must be a limit to staff resilience will also be broadly welcomed. However, that is of little consolation for those individuals who have already been effectively broken by unrealistic stresses and strains. Many oare temporarily or even permanently lost to the system, adding to the stresses and strains. Reports are of little benefit if they fail to affect the actions of those who have influence.
Its easy to see regulators as sources of perpetual, negative, fault-finding criticism. Yet the CQC aim to provide guidance on how to improve. For example, 2014/15 placed emphasis on the importance of medical leadership in resolving quality of care issues. They indicate this has been an important element in the progress mentioned in point 4. Good leadership will also be essential for resolving the reported variability and even deterioration of services in some locations. Team members whose services are classed as “outstanding” should be rightfully proud of their performance. Unfortunately, such rating is of little consolation to patients of the hospital or provider a few miles away where services are “inadequate”. Which brings us to the CQCs fifth point.
To put people first, there must be local collaboration and joined-up care
Numerous job-roles, including doctors of all types, and organisations working in harmony requires significant effort. Good leadership has already been mentioned. True collaboration and joined-up care is dependent on excellent team communication. Planning, organisation and implementation skills are also required along with the ability to help others learn how to participate in a complex system.
To repeat the comment from earlier: Reports are of little benefit if they fail to affect the actions of those who have influence. The reality is that every doctor has influence and has a role in achieving local collaboration and joined-up care. For a few, this may mean taking formal and potentially high profile leadership roles. For the many, it is the day-to-day attitudes and actions which will lead to success success. Developing an understanding of the system, the skills to communicate well with other teams, to take the lead when the situation requires and to implement change can all directly impacts on quality of care.
How do you see your role in developing local collaboration and joined-up care? What steps are you taking to be able to rise to the challenge?
Stephen McGuire – Head of Development
