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Revealed: the care black spots where patients are denied access to good hospitals and social care

The Telegraph logo The Telegraph 10/10/2018 Laura Donnelly

Access to good care is like a game of 'Russian Roulette"', Age UK says. © Getty Access to good care is like a game of 'Russian Roulette"', Age UK says.

Watchdogs have warned of a “growing injustice” as they reveal for the first time the country’s black spots where patients are routinely denied access to decent NHS or social care.

The Care Quality Commission today says social care has passed a “tipping point” in many parts of the country, leaving Accident & Emergency (A&E) departments under so much pressure that safety is compromised.

Its report warns that patients are being denied care they need, with half of A&E departments failing, amid rising avoidable admissions of elderly patients who should have received help elsewhere.

Inspectors said elderly hospital patients described being kept “ in a holding pen” with 40 other patients, as they waited for a place in a care home, or help in their own home.

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The watchdog said that in too many cases, pensioners struggled to get an appointment with a GP, leaving them to turn to emergency care or become so frail they had to be admitted to hospital.

The report also shows that half of maternity units remain unsafe, despite repeated NHS pledges to improve standards of care for mothers and new babies.

Inspectors said analysis from inspections of 30,000 services providing health and social care showed that access to care was increasingly dependent on where people live.

“Two years ago, we warned that social care was ‘approaching a tipping point’ - as unmet need continues to rise, this tipping point has already been reached for some people who are not getting the care they need,” the report states.

As evidence, the watchdog highlighted areas where the population has no decent local hospital, and worse than average standards in home care and residential homes.

Services in Portsmouth, the Wirral, Isle of Wight and Kent were pinpointed as causing particular concern,  with most hospitals found to be either inadequate or requiring improvement, with a lack of quality social care.  Similar problems were found in Eastbourne, East Sussex and Salisbury, in Wiltshire. In many such cases, patients were being denied care because there was no good hospital within half an hour’s drive, the watchdog warned.

And in a significant intervention, its chairman Peter Wyman warned that an extra £20bn promised to the NHS would end up being spent on patients who should never have ended up in hospital, if the Government did not make a “long-term funding settlement” for social care.

It comes ahead of a green paper on social care, which the government is due to publish later this autumn, when it details how the NHS spending boost will be deployed.

The report reveals swathes of the country which have almost no hospitals rated good or outstanding - with Dorset, Devon, Cornwall, Norfolk, Wiltshire, Shropshire, North Yorks and most of Kent among the areas highlighted.

It shows a sharp rise in rates of avoidable emergency admissions for older people between 2010/11 and 2016/17, with the highest increase - of 37 per cent - seen amongst those aged between 75 and 79.

It also warns of a growing crisis in social care, with figures suggesting nine out of ten care homes will not have enough places by 2022 unless action is taken, and rising vacancy rates of staff.

CQC also highlighted research showing that one in seven elderly people in need of care do not receive it at all - a rise of almost 20 per cent since 2015.

The report said staff working at care providers providing poor care admitted they had felt “disgusted” by the standards of services on offer, but felt unable to talk about it until problems were highlighted.

It warned that difficulties accessing GP care were fuelling the problems, with inadequate access to GPs out-of-hours in some areas, and public satisfaction with GPs the lowest it has been for 35 years.

“Inadequate access to GPs can lead to people relying on emergency services or reaching the critical point where they cannot access suitable care in the community. Across our reviews, older people told us it could be difficult to access their GP. Access to primary care support out of hours was also critical, but we found that people’s access to this support varied, and in some areas was not adequate,” the report found.

And it said too many mental health patients were being sent far from home for care - which was inappropriate in the “vast majority” of cases.

Caroline Abrahams, Charity Director at Age UK said access to care had become a game of  "Russian Roulette" with access to care now a matter of "pot luck".

“A good care service can make all the difference in the world for an older person in declining health and it’s wrong that they should have to play Russian Roulette with something so vital. Older people need to be confident they will get good care that meets their needs whether they live North or South, in the countryside or a major city.” 

Ian Trenholm, chief executive of the Care Quality Commission, said: “This year’s State of Care highlights both the resilience and the potential vulnerability of a health and care system where most people receive good care, but where access to this care increasingly depends on where in the country you live and how well your local health system works together.”

“The challenge for Parliament, national and local leaders and providers is to change the way services are funded, the way they work together and how and where people are cared for and supported. The alternative is a future in which care injustice will increase and where some people will be failed by the services that are meant to support them, with their health and quality of life suffering as result.”

A Department of Health and Social Care spokesman said: “It is testament to our hardworking, dedicated NHS and social care staff that the vast majority of patients continue to receive good, safe care and many parts of the NHS have improved since this time last year.

“We want the NHS to be the safest healthcare system in the world – and this starts by ensuring every single patient in this country receives the highest quality of care, no matter where they live. This is backed by our long term plan to guarantee the future of the NHS with an extra £20.5 billion a year by 2023/24.”

Watch: NHS from 1948 to 2018, and beyond [Sky News]

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