A woman with a history of arthritis and knee problems ended up being taken to A&E by ambulance because her GP practice was unable to respond swiftly when she developed a urinary tract infection at home.

The worrying case of the woman, whose first name is Bethany, appears in the Care Quality Commission’s (CQC) annual assessment of the state of health and social care in England that was published today (25 October).

Bethany’s experience highlights the kind of difficulties that many patients currently encounter when they contact their GP practice, the report says. She had phoned the practice first thing in the morning to arrange for some medicine for her infection to come with her afternoon medication delivery.

After waiting for more than six hours for a call back from her GP and becoming more unwell, Bethany phoned her pharmacist who then rang an ambulance to take her to hospital, the CQC report states.

‘This attendance at A&E may have been avoided if the GP had called her back and assessed her earlier. Bethany has arthritis and has a lot of experience of using health services, including waiting two years for a knee replacement operation. She said it was the care and services from primary care that she had been most unhappy about.’

People in deprived areas and ‘avoidable hospital care’

The CQC report points out that many people also face barriers when trying to access hospital services. It refers to NHS England data – which show a ‘concerning link’ between people living in areas of deprivation and rates of unplanned hospital admissions for chronic ambulatory care sensitive conditions.

The long-term conditions include chronic obstructive pulmonary disease, asthma and diabetes, which could potentially be avoided with timely and effective community care, the report suggests.

‘The rate of unplanned hospital admissions for these chronic conditions was 302 per 100,000 for the most deprived areas, compared with 104 for the least deprived. In other words, according to the most recent data, people living in the most deprived 10 per cent of areas in England were nearly three times more likely to be admitted for potentially avoidable hospital care than those in the least deprived areas. This pattern was reflected when looking at local authority areas.

‘The 10 local authorities with the highest rates of unplanned hospital admissions for chronic ambulatory care sensitive conditions were all areas of comparatively high deprivation: seven were in the North and three were in the West Midlands. The 10 local authorities with the lowest rates of unplanned hospital admissions were nearly all in comparatively affluent areas, and were all in London or the South East.’

The report also calls for a greater focus on children and young people’s services at both a national and local level. This should include consistent funding targeted to areas of early intervention, better understanding by systems of the gaps in provision of care and treatment for their population to ensure that local areas can meet the needs of their children, improved management of demand and communication with children and their families.

The health and wellbeing of a nation’s children has been described as the best predictor of its future prosperity; failing to ensure good, safe care for our children today also risks failing their future [Ian Dilks, CQC]

Focus on children and young people 

Ian Dilks, CQC chair, said: ‘This year’s State of Care describes issues with access to and quality of care and the impact on people who use health and care services – with particular focus on the many children and young people who are not getting the care they need when they need it. 

‘While some children are receiving timely, appropriate care, we know that there are more who don’t, with potential long-term repercussions for their mental and physical health. Action now – targeted funding for early intervention, better understanding of local need and improved management of demand, and genuine two-way communication with children and families – will help to ensure a healthier population tomorrow. 

Mr Dilks added: ‘The health and wellbeing of a nation’s children has been described as the best predictor of its future prosperity; failing to ensure good, safe care for our children today also risks failing their future.’

NHS ‘often left to deal with the fallout’ from austerity

Responding to the report, Layla McCay, director of policy at the NHS Confederation, said: ‘It is deeply worrying that the CQC has raised many concerns in this report that need to be addressed, particularly in relation to children’s services. Diagnosing and treating problems early can prevent much more long-term issues developing, reducing the risk of young people developing long-term mental or physical illnesses.

‘NHS leaders and their teams have been working incredibly hard to provide the care that patients need in the face of difficult conditions. As the CQC has found the NHS is experiencing a spike in children and young people coming forward for mental health treatment and we know that not everyone is getting access to the timely care they need. The lack of capital and flat revenue growth, highlighted in the recent report from Lord Darzi, has led to demand far outstripping capacity.

‘The CQC also found that problems accessing care are exacerbated by deprivation, with people living in the poorest areas more likely to need urgent and emergency care, particularly for people attending for mental health reasons. We cannot escape from the reality that, as a nation, the UK is less healthy and the cost of living crisis and years of austerity have exacerbated this situation. The NHS is often left to deal with the fallout. 

Dr McCay stressed that improving performance was a long-term ambition and that changes ‘cannot be achieved overnight’. She added: ‘We will continue to work closely with the CQC to support its organisational recovery so it can provide effective oversight of healthcare providers and systems.

‘We welcome reports suggesting that the NHS’ funding will increase in the upcoming Budget. In order to turn around the health service and achieve the government’s ambitions it will need the right support to meet rising demand, hit performance targets and reform services.’