How did health and social care for adults do last year?

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1 How did health and social care for adults do last year? Original document title: The state of health care and adult social care in England in 2011/12 easy to read

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3 What is in this paper? Page We are the Care Quality Commission 1 Changes in health and social care 5 What this means for good care 12 Next steps 24 How to contact us 27

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5 We are the Care Quality Commission We check health and social care services in England to see how well they are doing. Each year we have to write a report to parliament to say what we have found. This is the Easy to Read version of our report for last year 2011/ Name Address We get our information from: our lists of services the things people say who use services 1

6 numbers from other places and special checks we do on an area. Last year we did special checks on: how older people were treated in hospital and whether they got the right food, or help to eat services for people with learning disabilities. A main thing we have found is that as people are living longer their care gets more difficult. 2

7 This is because more people have more than one illness. It has meant: services are finding it more difficult to give person-centred care and meet people s needs there is more pressure on staff as they need to learn new things there are not enough staff. It is a difficult time for services to do their jobs well with these problems and less money around. 3

8 We do see a lot of services that are still able to do a good job and give great care. We also see other services that are not doing well enough. 4

9 Changes in health and social care We have more people living in England now, just over 53 million. + 1 in 6 people are 65 or over. Over 1 in 44 people are 85 or over. + More people are living longer which also means we have more people with poor health. + Now, 1 in 66 people have dementia. And, 1 in 3 people over 65 will get dementia. 5

10 This means services will need to change to care for these people properly. More and more people are living with things like: Diabetes heart disease breathing problems. 6

11 The good news is that more people are living longer, even if they have cancer and more than one illness. + 1 in 4 people will have mental health problems in their life. + All of these things mean more work for health and social care services. Work is more complicated as well. 7

12 + Changes in health care More people are going home after treatment to finish getting better there, instead of staying in hospital overnight. + More people have more than one thing wrong with them. This can make their care more complicated. + More NHS care is being done by private companies and this is expected to get bigger. Some NHS trusts have joined together so there are less of them. The NHS still needs to save 20 billion by There are more older people being treated in hospital now and if the work to help them go home isn t done properly more come back as emergencies. 8

13 Changes in adult social care There are less care homes now and nearly 1,000 extra home care services. + New types of support mean people can live at home for longer. + There are more places in: extra care housing + short stay nursing homes. + Nearly everywhere now has special support services that help people get independent again so they can leave hospital. 9

14 Because of people s complicated illnesses there is: more need for nursing care in the social care they live in + more nursing homes + more nursing beds. At the same time, councils are having money problems. More councils said they would only pay for care called substantial. Nearly half of people in care homes pay for themselves. 10

15 + 1 in 5 people pay for their home care. Some people add their own money to the money the council pays. + The number of people getting personalised care has gone up a lot. This is because of Direct Payments and personal budgets. 11

16 What this means for good care Because more people need more complicated care with less money things are difficult. Because we don't tell services when we come to check them we can see: 1. If care is getting better or worse. 2. What are the biggest worries for people who are less able to speak up for themselves, people with dementia, people with a learning disability and people with mental health problems. We see lots of services that are still able to give a very good service. We have put examples in the longer version of this report. We also see services that are not as good as they should be. We will chase up the ones that are not good enough to make sure they change and get better. 12

17 Health care We did a special check that looked at food and dignity for older people in hospital. Most hospitals did well. Staff worked well together to give people person centred care and treated them with kindness and respect. 1 out of 10 hospitals did not treat people properly or involve them in their care. Here we found: people did not have privacy they could not reach call bells staff spoke down to them. 13

18 Some patients in 45 hospitals didn't get the right food and drink and help they needed. There were 3 main problems: 1. Staff are used to doing things badly. 2. They are doing jobs not thinking about people. 3. There are not enough staff. 3 out of 4 trusts have made services better since we checked. We will carry on checking that things change. 14

19 When hospitals looked for new staff they checked to make sure they could do their jobs properly. But there are times in the NHS when suddenly more people need help than others. Some hospitals did better at managing this than others. Some hospitals did not have enough staff on at busier times. This made it more difficult to look after patients properly. Private hospitals did better as they don't these ups and downs. Nearly all of them: treated people properly had enough staff 15

20 had good training and support for staff. But private hospitals also have a lot of hospitals for people with mental health problems and people with a learning disability, and here we found some big problems. When we looked at services for people with learning disabilities only half of services gave good enough care. Nearly 3 out of 4 NHS services were good enough. Lots of people were stuck in services that were meant to find out what was wrong with you and help you get better and out quickly. We found people: did not have clear plans for leaving 16

21 were far away from their families had care that was not person centred. The private services were less good at keeping people safe from abuse, with staff not good enough as well. What had got better for private and NHS services was more of them treated people with dignity and respect. But this is a serious worry with many people not able to have a say about their care plans. Plans for people leaving hospital need to be better, patients leaving at weekends were more likely to come back as emergencies. 17

22 Adult social care When people s care got more complicated we saw their care could get worse. Looking after people s medicines properly was a problem, especially in nursing homes. Nursing homes were also less good at treating people well enough. Services that treated people well all: saw the person as an individual helped people think they were worth something 18

23 took time to talk and listen knew what people were feeling knew how well people were gave people control over their care and where they lived. 19

24 We still see care that does not do all of these things. We see staff: talking over the person, as if they were not there doing things to people, rather than with them getting people ready for bed at a time that suits the staff rather than the people being cared for. This is very worrying when people are not able to speak up for themselves. 20

25 When we looked at care homes for people with learning disabilities we found only 6 out of 10: were good enough in their care kept people safe. We did see some great examples where people were involved in their care and were in charge of their care plans. When there were problems we found: not enough person-centred planning they didn't know enough about what people liked and didn't like. 21

26 It is important that the people who buy these services make sure they all properly use person-centred planning. And we will carry on checking to see if they do. Making sure people are helped with food and drink is most important. We found 2 out of 10 nursing homes and 1 out of 10 care homes didn't do this properly. This is very, very worrying and we will look at it again next year. 22

27 People having more than one thing wrong with them and needing complicated care makes it more difficult for services to get the right staff. We found 1 out of 4 nursing homes and over 1 out of 10 care homes and home care agencies didn't do this properly. We found some services that did not have good managers and some didn't have a manager at all. Changing the manager could quickly make a service much better. Health and social care services did seem to be working well together. 23

28 Next steps We plan to use the information we have more. This will help make services better. People have said this is what they want us to do. We will: be clear about good care that works well and poor care Name Address say when different services do better than each other say when there are problems and what will make them better. 24

29 Next year our report will include: our work looking at the care people get in their own homes how people are treated and if they get enough food in 500 care homes and nursing homes how people are treated and if they get enough food in 50 NHS hospitals what we find out about the care people with dementia get when they go into hospital 25

30 what we find out about people waiting for NHS treatment the health needs of people with a learning disability what we find out about GP surgeries and practices. 26

31 How to contact us For more information, or to get in touch with us: Telephone: Web: Write to: Care Quality Commission Finsbury Tower Bunhill Row London EC1Y 8TG Please contact us if you would like this document in other formats or languages. 27

32 Credits This paper has been designed and produced for the Care Quality Commission by the EasyRead service at Inspired Services Publishing Ltd. Ref ISL 299/12. December Artwork is from the Valuing People Clipart collection and cannot be used anywhere else without written permission from Inspired Services Publishing Ltd. 28