NHS maternity and ambulance services in England are getting worse, with a rise in the number ranked inadequate for safety, a damning regulator report has found.
Some 65% of maternity services are now regarded as inadequate or require improvement for safety, up from 54% last year, the Care Quality Commission (CQC) said. Of these, 15% are inadequate.
A similar picture emerges for ambulance services – 60% are inadequate or require improvement on safety, double the 30% last year. One in 10 (10%) ambulance services are now ranked as inadequate compared with 0% last year.
Maternity and ambulance services have also got worse overall when it comes to looking at other areas of care. Some 49% of maternity services are inadequate or need improving overall (up from 39% last year), while the figure is 40% for ambulance trusts (up from 10%).
NHS Maternity Staff "Under Huge Pressure"
The CQC has been looking closely at NHS maternity and has now inspected 73% of acute hospital services. "The overarching picture is one of a service and staff under huge pressure," its report said, with issues including maternity staffing levels that fall below the recommended number needed.
The report added that the maternity model for providing cover "is often fragile, with the rotas relying on every consultant being available". It added: "On top of this, consultants face additional pressure from, for example, having to cover registrar rotas and extra on-call shifts to meet the needs of their service."
The report further pointed to issues with governance and lack of oversight from NHS boards, "delays to care and lack of one-to-one care during labour, as well as poor communication with women and difficult working relationships between staff groups".
Ambulance Targets Continue to be Missed
On ambulances, NHS data shows response times have improved since last winter, but a raft of targets are still being missed. The average response time in September for ambulances in England dealing with the most urgent incidents, defined as calls from people with life-threatening illnesses or injuries, was 8 minutes and 31 seconds – above the 7-minute target. Ambulances also took an average of 37 minutes and 38 seconds to respond to emergency calls such as heart attacks, strokes and sepsis. The target is 18 minutes.
In its wide-ranging report, the CQC warned that healthcare risks 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… Along the health and care journey, people are struggling to get the care they need when they need it."
Factors such as long waits for hospital treatment, waits to see GPs and for referrals, combined with a lack of staff, "increase the risk of a two-tier system of healthcare, with people who can't afford to pay having to wait longer for care and risking deteriorating health".
Research by YouGov showed that eight in 10 of those who used private healthcare last year would previously have used the NHS, while another study found 56% of people had tried to use the NHS before going private.
The CQC 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 £1200 on a credit card for private treatment, doing without household essentials until the debt was paid."
Concern Over Mental Health Services
In its study, the CQC further raised concerns about access to mental health care and about its quality. "Safety continues to be an area of concern, with 40% of (mental health) providers rated as requires improvement or inadequate for safety," it said.
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."
CQC chief executive Ian Trenholm said the ongoing strike action by NHS staff – who are unhappy with pay and conditions – had contributed to backlogs. But he said staff have told the CQC they are "overworked, exhausted and stressed" and that this can "affect their ability to provide safe and effective care".
Sally Warren, director of policy at think tank The King's Fund, said: "Public satisfaction with the NHS is at a record low. Despite this, and despite signs that some people are paying for care out of their own pocket while others simply go without, public support for the founding principle of services being free at the point of use remains rock-solid.
"History has shown us that a slow slide towards a two-tier health service can be avoided through a concerted effort to bring down NHS waiting lists, led and funded by Government."
A Department of Health and Social Care spokeswoman said: "It is vital we provide patients with the level of care they expect and deserve.
"That's why we are delivering on three major recovery plans to improve access to urgent and emergency, primary and elective care, and have made progress to significantly reduce the longest waits for routine treatment, despite pressures including industrial action…
"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."
Professor Sir Stephen Powis, NHS national medical director, said: "While the NHS has made improvements to maternity services over the last decade with fewer stillbirths and neonatal deaths, the NHS is also increasing investment to £186 million annually to grow our maternity workforce, strengthen leadership and improve culture, and working closely with select hospitals to ensure they make the necessary changes following recent maternity reviews, to ensure safer, more personalised and more equitable maternity care."