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Too many people in hospital due to lack of community services, warns CQC

Too many people with a learning disability or autism are in hospital because of a lack of local, intensive community services, inspectors have warned. 

They called for ‘more and better community care services’ in the latest annual State of Care report from the Care Quality Commission (CQC) published today (15 October). 

Many people with a learning disability or autism in hospital ‘have been there for a long time and are in a hospital that is out of their local area’, the document highlighted.  

It went on to raise concerns around the ‘quality of inpatient wards that should be providing longer-term and highly specialised care for people’.  

The CQC has rated 10% of inpatient services for people with learning disabilities and/or autism as inadequate as of September 2019, up from 1% in the year before.  

Meanwhile, the number of mental health beds has fallen by 14% between 2014/15 and 2018/19 and there are 2% fewer mental health nurses in April 2019 than in April 2014.  

Over the same period, the number of community mental health nurses rose, which may reflect the policy of moving away from hospital-based care but still represents an ‘unacceptable situation’, the report found. 

Community services must also improve to address the situation, the document went onto stress. 

For many with a learning disability or autism, ‘their hospital stay was prolonged because of delays in setting up the package of care they needed after they were discharged’, it explained. ‘In many cases, crises could have been averted if local health, care and education services had worked in unison to provide an integrated package to support them when they were young.’  

Organisations representing patients told inspectors that patients had increasing concerns around the availability of care and support services in the community such as the GP, added the report. 

The report also branded adult social care a ‘particular concern’.

It highlighted ‘fewer beds in nursing homes and care homes’, staff turnover rising ‘for the sixth year running’ and the registered nurse vacancy rate soaring from 4.1% in 2012/13 to 9.9% in 2018/19.  

The document added: ‘An estimated 1.4 million older people (nearly one in seven) do not have access to all the care and support they need.’ 

Staff in the sector shared major challenges ‘including a lack of qualified nursing staff, not enough high-quality registered managers, and high vacancy rates and staff turnover leading to a high use of agency staff’.

Staffing is the ‘make and break issue’ 

‘All of this underpinned by significant issues around staffing and workforce,’ the report concluded on the problems facing the NHS and social care. For example, there are 8% fewer learning disability nurses registered with the Nursing and Midwifery Council in 2019 than in 2015.  

The document went on to stress that the removal of nurse bursaries ‘has led to a reduction of people able to retrain’ and preceded a fall in applications to study nursing. However, it countered that the total number accepted into training each year has remained fairly stable at over 28,000. 

England director for the Royal College of Nursing (RCN) Patricia Marquis said the CQC report demonstrates that ‘official inspectors are putting England’s nursing shortage front and centre as a key reason for poor care'.

She continued: ‘Now that their concern is on record, it leaves Ministers with nowhere to turn – they must take immediate and firm action to address the 40,000 unfilled nurse jobs’.  

Ms Marquis went onto repeat the RCN’s call for the Government to put at least £1 billion extra per year into nursing education ‘if it hopes to recover lost ground and fill these vital jobs’. 

Also commenting on the report, director of policy at health and social care charity The King’s Fund, Sally Warren said it showed that ‘staffing is the make-or-break issue across the NHS and social care’. 

Ms Warren continued: ‘Staff are working under enormous strain as services struggle to recruit, train and retain enough staff with the necessary skills.’  

She raised concerns around the reduction in mental health nurses, stressing that ‘long held ambitions to put mental health on a par with physical health can only be delivered if sufficient numbers of suitably qualfiied and skilled staff are available’.  

‘To address the issues raised by the CQC and improve access to appropriate mental health and learning disability services will require urgent action to workforce shortages and put in place models of care that provide high quality care and support,’ she added.  

Ian Trenholm, chief exectutive of the CQC, said the report ‘highlighted mental health and learning disability inpatient services because that’s where we are starting to see an impact on quality – and on people’.  

He added: ‘Increased demand combined with challenges around workforce and access risk creating a perfect storm – meaning people who need support from mental health, learning disability or autism services may receive poor care, have to wait until they are at crisis point to get the help they need, be detained in unsuitable services far from home, or be unable to access care at all.’ 

The report comes as the latest vacancy statistics for England show 43,617 nursing vacancies, leaving 12% of full-time nursing posts now unfilled. This is an increase of more than 10% since the previous quarter.