Patient safety across health and social care services in England has been highlighted by the Care Quality Commission as its “greatest concern” in its annual inspection report.

Inspectors at the watchdog have rated 13% of hospitals and 10% adult social care services as inadequate for safety, alongside 6% of GP practices and out-of-hours services. Overall, 7% of services inspected so far have now been deemed inadequate on safety - a strong indication that care is unsafe - and the regulator said it was surprised at just how poor some of the care was. 

The report cites examples such as A&E patients being kept on trolleys overnight in a portable unit without proper nursing assessments, medicines dished out in a hospital without properly identifying the patient and not administered properly at a care home, and a lack of appropriate basic life-support training in GP practices as particularly bad examples of care.

Additionally, a substantial number of services - 61% of hospitals, 33% of adults social care, and 25% of GPs and out-of-hours - have been rated as ‘requires improvement’ for safety, because there is more they could do to ensure that they have a good safety culture.

The CQC’s assessment of the state of care in England in 2014/15 was based on its new, rigorous and expert-led inspection approach and ratings system, that kicked off in 2014 and is expected to close in April next year.

On the plus side, the analysis has also shown that, despite increasingly challenging circumstances, many services have actually managed to either improve or maintain quality.

Significant variation

Although the CQC has not finished inspecting all providers, more than 80% of GP practices and 60% of adult social care services inspected so far have been rated as good or outstanding and, of the hospitals rated, 38% were also found to be good or outstanding. However, alongside these encouraging findings, there remains significant variation in quality and an unacceptable level of poor care.

"The variation in care that we have observed is not just about the money. Good leaders are what make the difference – leaders who engage staff and people who use services and create a culture of continuous quality improvement... What is very clear is that isolated working and incremental changes are not going to be enough to meet the challenges ahead,” said CQC chief executive David Behan.

Rob Webster, chief executive of the NHS Confederation, said the report “shows the pressure our members are under during the toughest times of a generation and that variation still exists in care quality and delivery”, but also noted that “no organisation is an island so we need a fundamental shift in the way we regulate care”. 

“Leaders must be supported to deliver safe patient care and to transform the way we deliver care. This must be accompanied by an end to the ‘toxic’ environment that is creating a revolving door of NHS leadership, which is bad for the health service, and bad for patients,” he stressed.