Evidence used in this report

This report sets out the Care Quality Commission’s (CQC’s) assessment of the state of care in England in 2020/21.

We use data from our inspections and ratings, along with other information, including that from people who use services, their families and carers, to inform our judgements of the quality of care. Most of the analysis in this report is generated by CQC and is described in further detail below.

In our role as the independent regulator, we regularly publish our views on major quality issues in health and social care. This report includes data and insight from this work, including findings from our provider collaboration reviews, and our reports onsafety, equity and engagement in maternity services and ‘do not attempt cardiopulmonary resuscitation’ decisions during the pandemic.

We have also drawn from our programme of COVID-19 Insight reports, in particular:

• COVID Insight 6: designated settings and care home capacity
• COVID Insight 7: hospital bed occupancy and designated settings
• COVID Insight 9: the impact of the pandemic on urgent and emergency care
• COVID Insight 10: dental access during the pandemic
• COVID Insight 12: infection prevention and control in NHS trusts
• COVID Insight 12: identifying and responding to closed cultures
• COVID Insight 13: recovery of NHS hospital services

We have collected bespoke qualitative evidence to supplement our findings. Through this work, we have gathered data and insight from our inspection teams on quality issues within particular sectors of health and social care and/or on particular aspects of our monitoring and regulatory approach, for example our monitoring of the Deprivation of Liberty Safeguards.

We have conducted quantitative analysis of our inspection ratings of more than 32,000 services and providers. Aggregated ratings for the main sectors and services we regulate are provided in the data appendix of this report. In March 2020, we paused routine inspections and focused our activity where there was a risk to people’s safety. Since then we have continued to carry out inspection activity where there were risks to people’s safety or where it supported the health and care system’s response to the pandemic. We have also begun carrying out inspections in low risk services to quality assure our risk identification process. To provide as contemporaneous a picture as possible, the ratings in the data appendix are as at 31 July 2021.

This year quantitative analysis of inspection ratings includes information on the proportion of services rated as ‘insufficient evidence to rate’. This rating can be used when, on inspection, we have not been able to collect enough information to rate against one of the other ratings – ‘inadequate’, ‘requires improvement’, ‘good’ or ‘outstanding’. Charts in our data appendix visualise the proportion of all active services with a current rating of ‘inadequate’, ‘requires improvement’, ‘good’ and ‘outstanding’. The proportion of services rated ‘insufficient evidence to rate’ is provided in a note below the chart where applicable.

This report also provides an analysis of data submitted to CQC by providers in our Market Oversight scheme. This scheme covers providers that have a large local or regional presence which, if they were to fail, could disrupt continuity of care in a local authority area.

Our view of quality and safety has also been informed by our routine monitoring approach and engagement with providers, for example information collected through our provider information returns and our notifications data. In this report, we draw specifically on data and insight from our assessments of infection prevention and control in NHS trusts and in care homes, and our work with the Department of Health and Social Care, local authorities and individual care providers to provide assurance of safe and high-quality care in designated settings.

We have used the data and insight that we have gained from our engagement with voluntary and community sector organisations, provider representatives, health and social care leaders, practitioners and people using services in health and social care.

We have used information people have shared with us through ourGive Feedback on Care service, phone calls and social media to inform our views. We analysed a sample of 382 submissions received between April 2020 and December 2020 to understand issues related to how people access GP and dental services. The data was analysed to qualitatively explore nuances in the barriers and outcomes that people experience, and how these are interconnected. We have also used our surveys to inform what we say about what people think of the NHS healthcare services that they use.

We have included, in this report, personal stories of accessing and receiving care over the last year. We conducted seven interviews to understand the quality of care that people using services and/or their family members have received from local health and social care services, and the barriers they have faced in getting the care and treatment they need.

This report is informed by our wider horizon scanning activity. We have reviewed reports published by our stakeholders, drawn on national survey findings, and have analysed publicly available datasets to supplement our understanding of the challenges facing health and social care today and the experiences of people using services.

Evidence in this report, alongside our Annual Report and Accounts, enables us to fulfil our legal duties to report on equality issues and on the operation of the Deprivation of Liberty Safeguards.

Analytical findings have been corroborated, and in some cases supplemented, with expert input from our chief inspectors, deputy chief inspectors, specialist advisers, analysts and subject matter experts to ensure that the report represents what we are seeing in our regulatory activity. Where we have used other data, we reference this in the report.