This site is intended for health professionals only

Read the latest issue online
Winter work


NHS ‘gridlocked and unable to operate’, CQC report warns

NHS ‘gridlocked and unable to operate’, CQC report warns

The health and care system is ‘gridlocked’ and ‘unable to operate’, with staff struggling to provide good safe care as a result, the CQC has warned.

In its annual ‘state of care’ report, published on Friday, the regulator said that all too often patients were unable to access the care they needed, even though care was good when it was provided.

It also said that worsening access to primary care was leading to record drops in patient satisfaction and ‘exacerbating pressure’ on urgent and emergency services.

Patient satisfaction with access to GPs has fallen to its lowest ever levels across various surveys, the CQC said, and high numbers of patients had reported being unable to get through on the phone or finding there were no appointments if they did.

A third of patients who could not get an appointment with the GP did not speak to anyone about their reason for calling, which was concerning because ‘delayed or missed diagnosis could lead to worsening health and outcomes’, the CQC added.

But it said that general practice is busier than ever with the highest number of recorded appointments ever last winter and GPs facing intense workload and workforce challenges.

And the CQC  stressed that up to July this year, 96% of GP practices were rated as good or outstanding.

The report also highlighted that care homes are finding it ‘very difficult’ to attract and retain registered nurses, with some having to stop providing nursing care as nurses move to jobs with ‘better pay and conditions in the NHS’.

Reviewing five urgent and emergency care (UEC) areas – Cornwall and Isles of Scilly, Gloucestershire, Kent and Medway, Norfolk and Waveney, North East London – it also found that at four out of five UEC systems, people who were medically fit to be discharged from could not because there was insufficient social care capacity, including a lack of nursing care beds.

Adult social care providers have said they have been trying to source nursing staff from abroad – but this can be costly and involve a lot of retraining, with no guarantee the person will stay at the service once they have retrained and obtained their personal identification number in the UK, it added.

This comes after the annual state of care report, published earlier this month by Skills for Care, found nursing has the highest vacancy rates in the entire social care workforce. 

Across the NHS, the CQC report also found services were stuck with only two in five people able to leave hospital when they were ready and many people spending too long on waiting lists, with more than a third not feeling supported while waiting for specialist care.

At the heart of the problems were staff shortages and struggles with recruitment and retention across the board, it added.

The regulator said it had convened a group of 250 health and care leaders who described a system ‘in crisis’ and said they feared people coming to harm represents a worrying new status quo.

Patient dissatisfaction was mirrored by that of staff and without action now, the workforce will continue to decline, leading to even more pressure and worse outcomes for patients, the CQC warned.

In addition, inequalities were not being addressed and people in deprived areas were even less satisfied with being able to access services.

This includes ethnic minority-led GP practices being more likely to care for populations with higher levels of socio-economic deprivation and poorer health, which increases the challenges they have around recruitment and funding, the CQC said.

The CQC also had particular concerns about maternity services where the quality of care ‘is not good enough’ and services caring for people with a learning disability and autistic people where inspections were continuing to find problems.

CQC chief executive Ian Trenholm said: ‘The health and care system is gridlocked and unable to operate effectively.

‘This means that people are stuck – stuck in hospital because there isn’t the social care support in place for them to leave, stuck in emergency departments waiting for a hospital bed to get the treatment they need, and stuck waiting for ambulances that don’t arrive because those same ambulances are stuck outside hospitals waiting to transfer patients.’

He added there were lots of examples of great care and innovation, adding that ‘the fact is that it’s hard for health and care staff to deliver good care in a gridlocked system’.

He said: ‘There are no quick fixes, but there are steps to be taken now on planning, investment and workforce that will help to avoid continuing deterioration in people’s access to and experience of care.’

The report’s recommendations included:

  • Funding and support for ICSs to deliver a properly funded workforce plan that recognises the adult social care workforce crisis as a national issue and offers staff better pay, rewards and training linked to career progression
  • Better quality data and increased data sharing to understand care needs and tackle inequalities in people’s experience of and access to care
  • Workforce shortages across all sectors need to be addressed through innovative initiatives focusing on more flexible workforce models
A Department of Health and Social Care spokesperson said: ‘The Care Quality Commission’s report identifies the same priorities for improvement set out by the Health and Social Care Secretary in Our Plan for Patients.

‘The plan – ABCD – is designed to address ambulance pressures, bust the backlog, support care and discharge from hospital and improve access to doctors and dentists.’

NHS medical director Professor Sir Stephen Powis said:‘As this report recognises, NHS staff across the country are working hard to keep patients safe and despite record demand for our services and workforce pressures, patients continue to receive good NHS care.

‘The NHS has announced further measures to prepare for winter - from rapid response teams supporting people in their own homes to 24/7 control systems across the country, people should continue to come forward for the care they need and with winter weeks away, those eligible should get their flu and Covid-19 booster jabs.’

Last week, NHS England’s board issued a stark warning that demand for GP appointments is at record levels and ‘outstrips’ capacity.

A version of this story was originally published in our sister publication Pulse.

See how our symptom tool can help you make better sense of patient presentations
Click here to search a symptom

Visit Nursing in Practice Reference for details on 140 symptoms, including easily searchable symptoms and categories, offering you a free platform to check symptoms or search by category during a consultation to look for guidance on next steps.