CQC publishes fourth State of Care report

21 November 2013

‘Avoidable’ emergency admissions among the elderly increasing.

• More than half a million people aged 65 and over were admitted as an emergency to hospital with potentially avoidable conditions in the last year
• Almost one in ten aged 75 and over admitted as an emergency to hospital with potentially avoidable conditions
• The number of ‘avoidable’ emergency admissions varies with some parts of the country managing much better than others

The Care Quality Commission (CQC) has published expert analysis on the way people experience health and adult social care in England.

Findings from more than 35,000 inspections underpin its fourth annual State of Care report, which considers how care is delivered in hospitals, care homes, dental surgeries and in the community.

Key findings include:

• More than half a million people aged 65 and over were admitted as an emergency to hospital with ‘avoidable’ conditions in the last year – including almost one in ten aged 75 and over (396,000 people)
• The number of ‘avoidable’ emergency admissions varies from place to place, with some parts of the country managing much better than others
• People with dementia continue to have poorer outcomes in hospital
• Although CQC has seen some improvements in care across sectors, where inspectors find poor care it is serious and having a disproportionately large impact on people’s health and wellbeing.

CQC Chief Executive David Behan said: ‘Those responsible for care in local areas need to work together quickly to address the number of avoidable emergency admissions to hospital.  

‘GPs, care homes, home care agencies, community health services and hospitals, with local commissioners, must plan effectively make sure our older and more vulnerable people are cared for in the way they deserve. 

‘Where care can be provided for people outside of hospitals, it is better for them and eases pressures on hospital services.’

‘However, this year’s State of Care also shows we found examples of excellent care and I urge struggling providers to learn from their successful counterparts.’ 

We already know from research by others that many people, with a variety of conditions, are admitted to hospital often when it is not in their best interests.

Research carried out for State of Care reveals that the number of older people (aged 65 and over) with potentially avoidable conditions admitted as an emergency to hospital in England is on the rise, the State of Care concludes.

These conditions are potentially avoidable because they are manageable, treatable or preventable in the community or could be caused by poor care or neglect, such as pressure sores, bone fractures or dehydration. This suggests GPs and social care services could be working together better. 

The number of older people aged 65 and over admitted as an emergency with ‘avoidable’ conditions is up from 374,000 in 2007/8 to 530,000 in 2012/13. And this increase is greater than the increase in the growth of the population.

The increase in the numbers of people aged 75 and over being admitted as an emergency with these conditions is even greater, with a quarter of emergency admissions in this age group potentially avoidable in 2012/13. During 2012/13, more than nine per cent of people aged 75 and over across England experienced at least one emergency hospital admission for an avoidable condition (In 2007/08 it was about seven per cent.)

The report also shows that one person in five aged 90 and over is going into hospital as an emergency when that admission was potentially avoidable.

There are also significant regional variations in the numbers of older people going to hospital with avoidable conditions, with the North East having the highest rate of ‘avoidable’ emergency admissions (for people 65 and over per head of population) and the South West having the lowest.

Areas of the country that have a higher proportion of older people tend to have fewer ‘avoidable’ emergency admissions. This may be due to a greater awareness of the needs of older people in these areas and GPs, social care services and local hospitals putting a greater focus on developing systems to reduce admissions to hospital.

Among people living in care homes, emergency hospital admissions for avoidable conditions were 30 per cent higher for those who had dementia compared with similar people without dementia.

In the State of Care’s other assessments of quality in the health and social care sector, it acknowledges improvements but reports that poor care has had a disproportionately large impact on people using services in 2012/13.

During 2012/13, inspectors documented more cases of poor care that had a major or moderate impact on people - half of the cases of poor care our inspectors found fell into these categories.

State of Care also reports that despite some improvements, people who have dementia continue to have poorer outcomes in hospital compared with those without dementia. For example, deaths in hospital among those with dementia were over a third higher than similar people without dementia, emergency admissions were over a fifth higher, and the length of stay in hospital was over a quarter higher.

However, CQC has also congratulated staff working at the many providers that are delivering excellent care and has urged others to follow their lead. 

In this year’s State of Care, CQC analyses the quality of care by sector in the five areas of safety, care and welfare, respect and dignity, suitability of staffing and monitoring quality. Further explanation of these categories is in the notes to editors*.

Other key findings include:

Overall, our inspectors found poor care in around one in 10 of all hospital inspections.

• There has been no overall improvement in the NHS in treating people with dignity and respect.
• One in five inspections at nursing homes revealed safety concerns such as failing to give out medicines safely or not carrying out risk assessments when starting to care for someone, and ongoing staffing pressures.
• There is a link between high staff turnover in residential homes and numbers of death notifications, which may suggest that too much staff churn results in gaps in care.
• More than ten per cent of inspections of residential homes uncovered problems with either safeguarding and safety, staffing, or the care and support received by residents – for example, people not being helped to eat and drink enough.
• More than ten per cent of home care agencies did not meet standards in staffing or monitoring quality.
• Common quality issues at home care agencies include late or missed calls and this is known to have a profound impact on people using services, leaving people feeling vulnerable and devalued.

Ends

Notes to editors

If a provider fails to deliver the quality of care that people have a right to expect, CQC takes action that is proportionate to the impact on people who use the service, which could be minor, moderate or major.

The five areas we have presented in this report correspond to standards used in the current system that is being phased out. This sets out how we have matched them:

Safeguarding and safety

Suitability of premises (outcome ten), medicines management (outcome nine), cleanliness (outcome eight) and safeguarding (outcome seven)

Care and welfare

Care and welfare (outcome four) and meeting nutritional needs (outcome five)

Respect and dignity

Respecting and involving people who use services (outcome one)

Suitability of staffing

Staffing (outcome 13) and supporting workers (outcome 14)

Monitoring quality

Assessing and monitoring (16) and complaints (17)

Not aggregated are outcomes two, six, eleven and twelve and 21.  

• Numbers given for older patients with avoidable conditions do not equate for total admissions, but are for patient numbers.
• Avoidable conditions include diabetes, pneumonia, respiratory diseases, bone fractures, urinary infections, lower respiratory tract infections (both acute & chronic), pressure sores, pneumonitis, food and drink issues, intestinal infections

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