Care Quality Commission publishes its fifth annual report on the state of health and care services in England

• There is much excellent care but the variation in the quality and safety of care in England is too wide and is unacceptable
• Safe services occur where effective leadership builds a culture of safety
• By looking at CQC’s reports on outstanding and good care, other services can learn and improve
• CQC’s ratings provide transparent information that allow people to make choices

Over the past year, the Care Quality Commission’s (CQC) inspections have found front line staff delivering excellent care but inspectors have also found poor services where people were not getting the care they should expect. CQC says this variation in the quality and safety of care in England is too wide and unacceptable and has a detrimental impact on people who use health and care services and their families.

State of Care gives CQC’s perspective on the state of health and adult social care in England in 2013/14. It offers a unique perspective across more than 40,000 health and care services. CQC’s Chief Executive, David Behan said: "The findings from our inspections over the last year clearly show there is too much variation in quality and safety between services and within services.

People need to have confidence that they will get good care. Our role is to identify what works well and why, and what doesn’t work, and use this information to drive improvement and close the gap. "We have seen some excellent care in all sectors. For example the Accident & Emergency team that worked with patients to identify their support needs and meet those needs in the community, reducing the number of patients needing to be admitted to hospital. Or the care home where we saw how supporting people living with dementia was built into each care plan.

"In primary care, we saw an out-of-hours GP service that had a system to quickly identify and respond to the needs of people who had long-term conditions, complex needs and those needing end of life care, who received a call back from a duty doctor within 20 minutes or home visit within two hours.

"But we have also seen very poor care, such as the care home that inspectors found smelling of urine and where residents were still in bed at 10.30am, with many not getting the help they needed to eat breakfast. In one hospital we found that patients who had undergone surgery were being cared for in the recovery area for extended lengths of time. Patients were being returned to clinical areas that were inappropriate given the complexity of their needs.

"Our inspections have also found variation within services. For example, while most hospitals are rated at least good for the way they care for people, the majority require improvement when it comes to keeping people safe.

"While we will celebrate good and outstanding care where we find it, we are calling time on unacceptable inadequate care. When our inspections identify poor care, they must lead to improvement by providers, who should learn from the good and outstanding care we champion through our new ratings.

"We acknowledge the rising pressure on care services. Financial pressures are real but not unexpected, and yet we continue to see many examples of good and outstanding care even in financially challenged organisations.

"Understanding the quality of care is complex – it is about how people experience services, it is about the outcomes of the services and about how safe they are. Quality and safety is underpinned and influenced by the quality of the leadership and the culture that the leadership creates within a provider. We have found in our new more rigorous inspections that being well-led promotes quality and safety overall.

"From our inspections, the safety of services is our biggest concern. Care providers must make the basics of safe care a priority and build a culture of safety in their organisations, learning from the best. The principle of keeping people safe from harm is fundamental. Strong, effective leadership at all levels in an organisation is vital. Our new inspections have found that good leadership drives up quality and safety overall."

What needs to be done

• The public should be at the heart of good care. Our judgments will help people make choices about their care and become more demanding of those who should be acting in their interests.
• Providers should accept where there are problems and use our inspections to drive up quality.
• Some services need help to improve. When we identify failings, the wider health and care system needs to work together and help to put things right for the safety and wellbeing of people who use services.
• CQC will use its new approach to regulation to shine a light on poor quality care and highlight good and outstanding care and encourage a learning culture in organisations.

Many of the issues raised in this report involve new approaches across the NHS. That is why CQC supports NHS England and the other NHS leaders’ Five Year Forward View, due to be published soon, setting out why the NHS needs to change and what it needs to do in order to meet the needs of patients and close the care gap. CQC looks forward to seeing how the plans will improve the quality of care.