Healthcare delivery


the Faster Diagnosis Standard (FDS) in April 2021. The target is that, by March 2024, at least 75% of people should either receive a cancer diagnosis or have it ruled out within 4 weeks (28 days) of an urgent GP referral. In August 2023, NHS England confirmed plans


to consolidate the 10 performance standards for cancer, including the FDS, into three key standards. This includes the ‘28-day Faster Diagnosis Standard’, which outlines that patients with suspected cancer who are referred for checks by a GP, screening programme, or other route should be diagnosed or have cancer ruled out within 28 days. It is important to acknowledge that national data does not always fully reflect people’s experiences. Research from Healthwatch3 published in July 2023 highlighted an additional ‘hidden wait’ specifically for cancer care. In this survey of 385 adults who were referred or expected to be referred for cancer treatment, almost half (45%) said they were not referred for suspected cancer at their first appointment, and over 1 in 4 (28%) had to wait up to a month after their first appointment to be told they were being referred. As with the delays in GP referrals for other conditions, in some cases, people said this was because the GP team wanted to try other treatment or medication first before referring them. But in other cases, people described feeling that their condition was not being taken seriously, or that they felt they struggled to make themselves heard or understood. Once they received a referral, people said they


often faced ongoing delays. This is supported by data from NHS England, which shows that overall waiting times for people waiting to start cancer treatment are continuing to get worse. In the period April to June 2023, of those receiving their first treatment, 18,193 people (40%) had waited more than two months to start treatment following an urgent GP referral. In its July report, Healthwatch England also found that nearly a quarter (23%) of people who experienced a delay in their cancer referral said their condition deteriorated. Respondents also highlighted the negative impact on their mental health and wellbeing. This is supported by the findings of an April


2023 survey of 1,000 UK adults who have had or currently have cancer. Carried out by cancer charity Maggie’s, it found that 3 in 5 (58%) respondents said they felt that the mental challenge of cancer is harder to cope with than the physical treatment and side effects. In addition, 52% of people with cancer who responded said they felt there was support for the physical impact of cancer, but not for the emotional effects.4


Workforce challenges Staff regularly fed back to the CQC of being overworked, exhausted and stressed – sometimes to the point of becoming ill, injured or leaving their job altogether. They reported that this can affect their ability to provide safe and effective care to people. Just over a quarter (26%) of NHS staff were also satisfied with their level of pay. This is 12 percentage points lower than before the pandemic. Dissatisfaction with pay is linked to industrial action by healthcare staff during 2023. In adult social care, some providers are struggling to pay their staff a wage in line with inflation. Over half of the respondents to the survey of adult social care providers in England said they were having challenges recruiting new staff, and 31% said they were having challenges in retaining them. Despite this, there has been a steady decrease in staff vacancy rates for care homes, from 11% in January to March 2022 to 7%


The combination of the cost-of-living crisis and workforce challenges risks leading to unfair care, with those who can afford to pay for treatment doing so, and those who can’t facing longer waits and reduced access. Ian Trenholm, CQC’s Chief Executive


20 www.clinicalservicesjournal.com I January 2024


in April to June 2023. In 2022/23, approximately 70,000 people arriving to work in the UK from overseas started direct care roles in the independent adult social care sector, compared with around 20,000 in 2021/22. Providers of adult social care services have told CQC that recruiting staff from overseas has enhanced the diversity and skills of their team and helped resolve staffing issues. But there is a growing trend of unethical


international recruitment practices. In 2022/23, CQC made 37 referrals for concerns regarding modern slavery, labour exploitation and international visas – more than four times the number made in 2021/22.


Maternity


CQC has continued its focused programme of maternity inspections, with the overarching picture of a service and staff under huge pressure emerging. Ten percent of maternity services are rated as inadequate overall, while 39% are rated as requires improvement. Safety and leadership remain particular areas of concern, with 15% of services rated as inadequate for their safety and 12% rated as inadequate for being well-led. The CQC said that although it was


encouraging that all units inspected so far have adjusted consultant cover to meet recommendations made in the Ockenden report, the cover model is often fragile, with rotas reliant on every consultant being available. CQC has seen examples of services taking action to manage staff shortages safely – but it has also seen issues with governance and lack of oversight from 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. Additionally, women and babies from ethnic minority groups continue to experience higher


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