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'No improvement' in patient safety

Hospitals have made "no improvement" in monitoring the quality of patient care in light of the Mid Staffs scandal and "no improvement" in keeping patients safe or treating them with dignity, a major report has said.

Poor hospital care in the last year was also more likely to have had a negative impact on patients than the previous year, the review of NHS and social care services in England found.

More than half a million people aged 65 and over are now being admitted to hospital in an emergency with avoidable problems, the Care Quality Commission (CQC) report also showed.

These problems include malnutrition, pressure sores and urinary tract infections.

There has been a 64% increase in the last six years in p neumonia admissions among older people, while i nhalation of food or liquid has led to a 52% rise, and admissions for urinary tract infections have seen a 45% increase.

The report said: "In the aftermath of the failures of care at Mid Staffordshire NHS Foundation Trust, our inspectors' biggest concern in 2012/13 was that acute hospitals made no improvement in assessing and monitoring the quality of care they provided.

"We also found no improvement in safety and safeguarding, or in hospital patients being treated with dignity and respect.

"Around half (47%) of the problems we uncovered in our inspections in the NHS in 2012/13 had a major or moderate impact on patients.

"This is a deterioration from the previous year (39%)."

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

Looking at dignity and nutrition for older people, the CQC said it was "alarmed to see that there were fewer hospitals where patients were always treated with dignity and their privacy and independence respected".

It said it was "clearly unacceptable that this position, poor to begin with, had deteriorated further."

Problems included staff discussing confidential patient details in public and staff "talking over patients as though they were not there".

Patients could not always reach call bells and some staff did not respond to them in a reasonable time, the report went on.

On social care, the report said the care received by many people in 2012/13 was "still poor".

One in five nursing home inspections revealed safety concerns, such as failing to give out medicines safely.

In half (51%) of cases where inspectors found problems with adult social care, this had a major or moderate impact on people which was "no better than the previous year".

The report added: "We issued more warning notices to tackle this poor care - 818 in 2012/13, compared with 598 the previous year - an increase of almost 40%."

The report sets out CQC's findings about the quality of care in the year to March 31 2013, and is based on more than 35,000 inspections.

An even more rigorous inspection and regulatory process - looking at a wider array of data - has been implemented by the CQC this year.

The study found more older people are now being admitted to hospital in an emergency and this is increasing faster than the growth in the older population.

Those admitted with avoidable conditions is up from 374,000 in 2007/8 to 530,000 in 2012/13.

Among people aged 75 and over, a quarter of all emergency admissions in 2012/13 were avoidable, up from 21% in 2009/10.

The CQC said these problems were either preventable due to the fact they can usually managed in the community or because they can often be caused by poor care or neglect.

A mong people living in care homes, hospital admissions for avoidable conditions were 30% higher for those who had dementia compared with those without dementia.

In one nursing home in Romford, Essex, inspectors said "p eople were not supported to eat and drink enough".

One patient needed high calorie foods but was not offered any.

"We also noted that, despite the person not having regained the weight loss, staff had not monitored the person's weight for the previous three months."

In another home, people who were bed-bound did not have drinks readily available.

David Behan, chief executive of the CQC, 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 to 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."

Nuffield Trust chief executive Andy McKeon said the quality of care provided to people in England has improved in many key areas over the past decade.

"As today's CQC report has identified, some aspects of care are causing concern, such as urgent care and the prevention of emergency admissions, and need to be tackled immediately.

"The CQC's report rightly identifies the need to ensure appropriate levels of nursing staff and the rising pressure on urgent care, especially for conditions that could be treated in the community and not in hospitals.

"Providing high quality and timely care outside of hospitals must therefore be a major priority."

Professor Keith Willett, NHS England's director for acute episodes of care, said: "W e've got to provide better services outside of hospital.

"Our urgent care system will always be there to provide a safety net but we must make sure it's used effectively. It's clear there are opportunities for improvement in many parts of the country and we need to change the way we provide services in order to deliver better services for patients .

"Health services across the country, particularly those in difficulty, need to look at the areas which are doing well. Those areas succeeding have very high elderly populations and have learned the skills of how to deal with their problems effectively in the community."

Dr Peter Carter, chief executive of the Royal College of Nursing (RCN), said: " Thousands of older and vulnerable patients are waiting for hours in A&E corridors with conditions which could have been prevented. Thousands more are battling loneliness as paid carers are forced to reduce the time they spend visiting patients due to financial cutbacks.

"We support moving care from hospitals to communities because it is better for patients.

"However, far too often we have seen decisions made based on financial necessity rather than patient need, with services being removed from hospitals while community teams are still pitifully short-staffed.

"One in five care homes has staffing pressures and this means that vulnerable patients are not getting the care they deserve."

Shadow minister for care and older people Liz Kendall said: "This report shows the full scale of David Cameron's care crisis.

"Avoidable emergency admissions to hospital for the over-65s have topped half a million for the first time, and are rising faster than the increase in the ageing population.

"This is terrible for older people, and putting huge extra pressure on already-struggling A&Es.

"It is also an appalling waste of taxpayers' money, costing around a billion pounds a year."

Care and support minister, Norman Lamb, said: "This report shows why we are right to be changing the NHS in patients' interests.

"Many more people are living longer with complex care needs. That is why we are transforming the way health and social care is given across the country through a joined-up and integrated approach.

"Only last week, we announced the biggest changes to the GP contract in a decade, which will bring back the strong personal connection between millions of older people and their family doctor, who know their patients best and will be accountable for their care round the clock."

A spokesman for the Alzheimer's Society said: " It is a national disgrace that people with dementia are being let down so profoundly.

"With a quarter of people in hospitals and 80% of people in care homes living with dementia, caring for them should be core business of health and care services."

Overall, one in 10 health and adult social care services in England had poor care in this year's report.

Last year, the figure was 27%.

Katherine Murphy, chief executive of the Patients Association, said: " Avoidable admissions drain much needed resources from the NHS, but more importantly, they cause huge amounts of distress and discomfort to those patients that would much prefer to be cared for at home.

"This issue needs to be resolved, but won't be until the health and social care system are properly joined together, ensuring that there is effective communication and that patients are not sent to Accident and Emergency because it is considered to be the only available option.

"Patients need to be able to access high quality services in the community, with doctors, nurses and pharmacists working pro-actively in the interest of patients. The postcode lottery also needs to end. Patients need quality services wherever they are based.

"We also need to ensure that the primary care system has a culture that focuses on assisting people to remain at home, and has the resources that it needs to do so."

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