The Care Quality Commission (CQC) has released its 2023/24 State of Care report, highlighting critical issues across England’s health and adult social care systems. Problems range from inadequate maternity services to delays in discharge processes, with key insights aimed at guiding NHS England’s ongoing initiatives and local authority actions.
Maternity Care Shortcomings
Among 131 maternity service locations inspected, nearly half (47%) were rated as either "requires improvement" (36%) or "inadequate" (12%). At 12 locations, ratings for "well-led" care dropped by two levels, while 11 locations experienced a similar decline in "safe" ratings. NHS England’s three-year delivery plan for maternity includes initiatives aimed at addressing these safety and quality issues.
“Too many women are still not receiving the high-quality maternity care they deserve,” the report emphasises. These findings underscore the need for continued work on safety improvement initiatives already underway.
Learn more: Midwifery Practice and Maternity Care
Emphasising Patient Voice with Martha’s Rule
The report highlights "Martha's Rule," introduced to reinforce patient and family voices in healthcare. Named after a young patient, the rule promotes listening, respect, and open communication among health professionals, focusing on person-centred, responsive care.
“Martha's Rule reinforces the fundamental principles of listening to people who use health and care services and their families – and acting on what they say,” states the CQC, highlighting that the rule encourages “effective teamwork, mutual respect, and a culture of learning and improvement.”
Learn more: Martha’s Rule: Patient Safety
Deprivation of Liberty Safeguards (DoLS) Challenges and Mental Capacity Act Understanding
The report reveals variation in how local authorities manage Deprivation of Liberty Safeguards (DoLS) applications. Some areas experience significant backlogs, with external stakeholders describing the system as “not working” with “no movement once the application has been submitted.”
Concerns are also raised about the application of the Mental Capacity Act (MCA), with some managers and staff reportedly lacking confidence in applying MCA principles, leading to inconsistencies in care records, mental capacity assessments, and best interest decisions.
“Any action taken as part of the DoLS process must be in line with the principles of the Act,” the report cautions, urging for clearer, more documented processes involving appropriate individuals in best interest decisions.
Learn more: Safeguarding Rights: Navigating DoLS in Care Settings 2025
Discharge Delays and Intermediate Care
The report discusses intermediate care and its role in improving patient flow and discharge from acute and community hospitals. However, frequent delays continue due to internal processes, such as waiting for pharmacy services, diagnostic tests, and therapy assessments. A lack of capacity in adult social care further impacts hospital discharge flow.
“When intermediate care works well, it can improve flow and discharge from acute and community hospitals,” notes the report. “But ongoing delays due to internal processes and social care capacity continue to limit effectiveness.”
Learn more: Improving Discharge Practice
Child and Adolescent Mental Health Services (CAMHS)
The report describes a rising demand for mental health services, especially for children and young people. There is an urgent need for increased capacity in Child and Adolescent Mental Health Services (CAMHS), as service requests continue to grow alongside adult mental health demands.
“The demand for adult mental health services continues to grow, and even more so for children and young people,” according to the report, pointing to a pressing need for expanded resources and targeted support for younger patients."
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Find out more about the CQC's State of Care Report 2023/24 here