Maternity and ambulance services worsening with more ‘inadequate’ on safety

The quality of maternity and ambulance services has worsened, with an increase in the numbers not meeting standards for safety, a damning regulator report reveals.

Some 65 percent of NHS maternity services are now inadequate or require improvement for safety, up from 54 percent last year, the Care Quality Commission (CQC) said. Of these, 15 percent were inadequate.

A similar picture emerged for ambulance services – 60 percent were inadequate or required improvement for safety, double the 30 percent last year. One in 10 were inadequate, compared with none last year.

The CQC’s annual state of care report also considered whether services were effective, caring, responsive and well-led.

When it came to overall ratings, 49 percent of maternity services were inadequate or needing improving overall, along with four in ten ambulance trusts – both up from last year.

After inspecting maternity services at 73 percent of hospitals, the CQC described a worrying picture of high pressure plus staffing levels below the recommended numbers.

It said the model for providing cover was “often fragile, with the rotas relying on every consultant being available”.

Kate Terroni, the regulator’s interim deputy chief executive, said there was a “deteriorating picture in maternity services” and women are not always listened to.

Meanwhile, NHS data shows ambulance response times have improved since last winter but a raft of targets are still being missed.

The CQC warned that healthcare risked becoming a two-tier system, with society divided into those who can pay for care and those who cannot.

It said: “Getting access to services remains a fundamental problem… People are struggling to get the care they need when they need it.”

Polling by YouGov showed eight in 10 of those who used private healthcare last year would previously have used the NHS.

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The regulator added: “People may also be forced to make difficult financial choices. We heard from someone who receives benefits who resorted to extracting their own tooth because they were unable to find an NHS dentist.

“They then had to pay £1,200 on a credit card for private treatment, doing without household essentials until the debt was paid.”

Four in ten mental health providers were also rated as requiring improvement or inadequate for safety.

Inspectors pointed to a lack of beds, meaning people can be “cared for in inappropriate environments – often in emergency departments.

“One acute trust told us that there had been 42 mental health patients waiting for over 36 hours in the emergency department in one month alone.”

The report’s section on social care found councils were struggling to meet rising requests for adult support and some people were cutting back on their home care amid the cost-of-living crisis while “completely overwhelmed” family carers try to fill the gaps.

Providers are facing increased running costs including food and electricity, which has led to higher rates for those receiving care.

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Sally Gainsbury, senior policy analyst at Nuffield Trust, said the report showed the consequences of a healthcare system “fighting ever-multiplying fires”.

She added: “Strike action, growing waiting times and a rapidly deteriorating financial picture due to rising costs are severely testing the resilience of health and care services.

“There are troubling signs that fairness and access for all is being put in peril, with some of those most in need of care unable to gain timely access, and persistent inequalities for people from minoritised ethnic groups.”

Professor Sir Stephen Powis, NHS national medical director, said staff had faced unprecedented pressures in the last year, including a record 25.3 million A&E attendances, 14 million more GP appointments and tens of thousands more mental health appointments.

Improvements to maternity care over the last decade had led to fewer stillbirths and neonatal deaths, and the NHS is increasing investment to £186 million annually to grow our maternity workforce and improve care, he said.

Prof Powis added: “As the CQC have said, industrial action has had an impact that cannot be ignored – hundreds of thousands of routine appointments had to be rescheduled during the year this report covers.

“Despite this, hardworking staff continue to bring down the longest waits – latest data shows more patients were treated in August than the same month before the pandemic.

“We don’t want anyone to put off coming forward for care or to think they are a burden on the NHS, like many did during the pandemic – so as ever, please come forward for the support you need.”

A Department of Health and Social Care spokesperson said it was delivering three recovery plans to improve access to urgent and emergency care, planned treatment and primary care.

They added: “[We] have made progress to significantly reduce the longest waits for routine treatment, despite pressures including industrial action.

“We are also investing record sums into health and social care services to improve access to care and cut waiting lists, one of the government’s top five priorities.

“There are record numbers of staff working in the NHS and our historic Long Term Workforce Plan will retain and recruit hundreds of thousands more staff alongside harnessing technology to reform the way we work and save staff time.”

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