A new report from the Care Quality Commission (CQC), published today, highlights medicines management is the area of most concern in the adult social care sector, where over a quarter of providers inspected failed to meet Government standards as at 31 March 2012. The first CQC quarterly “Market Report” publishes collated statistics relating to the four areas of health and social care that are covered by the remit of the CQC (NHS Healthcare, Independent Healthcare, Adult Social Care and Primary Dental Care), for inspections taking place from the start of the new regulatory system until 31 March 2012. Of these four areas, Adult Social Care was the sector with the highest proportion of providers falling below Government standards. Over three thousand adult social care providers (27.4%, 3234) failed to meet at least one standard and had been required to produce an action plan setting out how they were to improve compliance. Even more worryingly, 1% of adult social care providers inspected (123) required urgent action to meet standards.
The report’s findings certainly give cause for concern on a number of different levels. Firstly, it is clear that a higher proportion of adult social care services are failing to meet standards than in any of the other areas inspected by the CQC. Leaving aside the higher numbers of adult social care providers inspected in the report’s timeframe, this provides even further evidence of the need for serious attention to be given to reforming the regulatory system for adult social care. Second, similar problems including staffing levels, record keeping and the care and welfare of service users were highlighted as concerns across both health and social care providers. This suggests that there are significant problems within the health and social care sector that could be addressed through comprehensive review of how services are funded and provided. Third, the report found that management of medicines was a concern across all sectors. In the adult social care sector, the report found that there will medicines management issues in 16.3% of home care services, 16.4% of residential care homes, and 20.4% of nursing homes. The proportion of nursing homes where there are problems (one in five) is likely to cause the most concern, as those people with the most complex healthcare needs are likely to be placed in nursing care.
There are specific concerns for people with dementia living in adult social care where there are problems with medications management. Two areas where there could be particularly detrimental effects on a person with dementia would be where medications designed to treat dementia (e.g. cholinesterase inhibitors) are not being given regularly, as this may have a detrimental impact on their effectiveness, or where neuroleptic drugs including antipsychotic drugs and sedatives are prescribed to control challenging behaviour but without clear instructions on their use. This could potentially lead to over-use of these medications with consequent over-sedation, or other adverse effects.
Despite the problems identified by this report, however, the CQC is to be commended on publishing statistics in this way for the first time. In the past, it was more difficult to see where there were common problems across healthcare sectors and services. For the future, it can only be hoped that the quarterly provision of this type of information will help to address why there are certain issues that pose problems across the sector. Interrogating why particular issues come up across the sector could potentially help to highlight where regulatory changes might support the provision of better services.
Care Quality Commission: www.cqc.org.uk