Ted Baker: We need an honest view about the quality of services

Yesterday, HSJ editor Alastair McLellan questioned whether Care Quality Commission’s recognition of improvement at a time of unprecedented pressure on the health and care system indicates a dissonance with “the service’s lived reality” that could cost the NHS funding. To some extent, he answers his own question – our view of quality is nuanced.

Our detailed assessments are based on what matters to people, use teams that include frontline clinical professionals and draw on interviews with staff and patients – people’s “lived reality”. Simplistic views about quality can be a barrier to understanding: some aspects of care – such as the substantial progress in the recognition and treatment of sepsis – are improving, while others – delays in emergency departments, elective waiting lists – are deteriorating.

Overall view

Our methodology gives us an overall view about quality, which in many areas is improving, although – as I highlighted at the meeting referenced in Alastair’s article – we are particularly concerned about urgent and emergency care.

What is important is that all parts of the system collaborate to create what we all want – high quality services that meet the need and expectations of patients 

Last month, I brought together over 40 clinical leaders from 24 emergency departments to discuss the key challenges they are facing right now, to share practical solutions to tackling these problems and to consider preparation strategies for future surges in demand. We will be publishing a full report based on the findings of this workshop, and of our inspections of emergency departments over the winter period, in the next few weeks.

To recognise the hard work and commitment of staff that has led to improvements in many trusts at a time of immense pressure does not invalidate the argument for more resources. Indeed, the CQC has repeatedly called for a sustainable funding solution for the health and social care, and consistently used our independent voice to highlight the pressure the system is under and to make the case for change.

With last year’s State of Care report we sent a clear message that the system is straining at the seams and quality of care is precarious. The sustainability of the health and social care system is one of the biggest challenges we as a society face. More resources are certainly needed, although this in itself will not solve the problem. The solutions are not simple, and there are no quick fixes.

We have never shied away from saying that there are real and continuing risks to maintaining quality – and that many have fallen short of achieving it. Equally, however, we will highlight and celebrate good care and improvement where we find it.

The fact that many trusts are improving quality despite significant challenges is a reason for optimism that together we can solve the problems the system faces. The long term solution must be for health and care providers and commissioners to collaborate to deliver services that meet the needs of their local population, with a stronger focus on keeping people well and helping them stay out of hospital, and on reducing variation that can inhibit people’s access to and choice of services.

What is important is that all parts of the system collaborate to create what we all want – high quality services that meet the need and expectations of patients – and that this work is informed by an honest view about the quality of services, both good and bad.