Evidence used in this report

This report sets out the Care Quality Commission’s (CQC’s) assessment of the state of care in England in 2021/22.

We use data from our inspections and ratings, along with other information, including that from people who use services, their families and carers, to inform our judgements of the quality of care. The evidence used in this report includes national published data and reports, as well as evidence generated by CQC. Further detail relating to the evidence used in this report is provided below.

Our view of quality and safety has been informed by information people have shared with us through our Give Feedback on Care service, phone calls and social media.

• To understand access issues in general practice, we analysed a random sample of 410 comments received through Give Feedback on Care in October 2021. We reviewed a further 113 comments received between January and March 2022, to see whether issues identified in October 2021 and last year’s State of Care report were still prevalent. This latter sample was selected at random from an extract created using a keyword search method looking for terms related to access.
• In dentistry, we looked at a random sample of 127 Give Feedback on Care comments received between March and May 2022 that were selected from an extract created using a keyword search method looking for terms related to access. We did this to understand how issues related to people’s access to NHS dental services had changed since we reported on these issues in our publication COVID Insight 10: dental access during the pandemic, as well as last year’s State of Care report.
• Our findings relating to the Deprivation of Liberty Safeguards (DoLS) are informed by details received through Give Feedback on Care. We analysed a sample of 310 comments submitted between April 2021 and March 2022 that spoke to people’s experiences with DoLS. The sample was created using a keyword search method looking for terms such as ‘DoLS’ and ‘liberty’.

We have drawn on findings of our published surveys to inform what we say about what people think of the NHS services that they use. Also, we have also drawn on data and insight from bespoke surveys that we commissioned.

To complement our own work and help us understand people’s experiences of health and social care, we commissioned Ipsos to carry out a survey. Ipsos carried out telephone interviews between 17 May and 12 June 2022 with people aged 65 and over living in England who had used health or social care services in the previous 6 months. A total of 4,013 people completed the interview.

In the Ipsos survey, quotas were set by age, gender and integrated care system to ensure that interviews were conducted all over England. Responses were also monitored by ethnicity and social grade. The results were weighted by these 5 variables to ensure that the final results matched the population profile of people aged 65 and over living in England. A limitation of the methodology used is that some groups of people using social care services are likely to be under-represented in the survey, namely people living in care homes and people with substantial or critical social care needs living in the community.

We commissioned Traverse to explore people’s experiences of accessing GP services since the outbreak of the COVID-19 pandemic. They surveyed members of an online panel, targeting English adults who have tried, successfully or not, to access a GP service in the past 12 months. Emails were sent to panellists selected at random from the base sample. Quotas were set to ensure an adequate spread in terms of region, age, gender, ethnicity, socio-economic background, carer status and long-term conditions. The online survey was completed by a total of 2,087 people between 10 and 15 November 2021.

We commissioned PEP Health to conduct a longitudinal analysis of their data on ‘patient experience’ across England. PEP Health gathers, analyses and interprets patient feedback from across the web and combines it to create a patient experience score. Comments are analysed using custom Natural Language Processing models to identify the relevance of a comment, which topics are discussed – for example, the speed of treatment and clarity of communication – and the strength of sentiment for each of these topics.

PEP Health’s data is gathered from a variety of sources with different user bases, resulting in diverse feedback. This data helps inform our picture of people’s experience for this report, alongside survey and other data. However, the data will not capture the views of all people who use services, families and carers.

We have used the data and insight that we have gained through our routine monitoring of and engagement with providers, for example information collected through our provider information returns and our notifications data.

In this report, we draw specifically on vacancy, turnover and occupancy data returned by adult social care providers between 1 April 2021 and 31 August 2022.

We also include analysis of information shared with us up to 30 June 2022 through the adult social care workforce pressures survey. This was introduced in December 2021 to facilitate discussions around workforce challenges between our inspectors and adult social care providers. Surveys are completed when we carry out an inspection or other monitoring activities. As a result, for some services the survey has been completed more than once and all responses from the same provider have been included in this analysis.

This report provides an analysis of data submitted to us by providers in our Market Oversight scheme, as well as information and insight gained from our engagement with providers within the scheme. The scheme covers providers that have a large local or regional presence and which, if they were to fail, could disrupt continuity of care in a local authority area.

We have conducted quantitative analysis of our inspection ratings of more than 33,000 services and providers. Aggregated ratings for the main sectors and services we regulate are provided in the data appendix of this report. In March 2020, we paused routine inspections and focused our activity where there was a risk to people’s safety. Since then we have continued to carry out inspection activity where there were risks to people’s safety or where it supported the health and care system’s response to the pandemic. We have also begun carrying out inspections in low risk services to quality assure our risk identification process. To provide as contemporaneous a picture as possible, the ratings in the data appendix are as at 31 July 2022.

This year quantitative analysis of inspection ratings includes information on the proportion of services that are categorised as having ‘insufficient evidence to rate’. This rating can be used when, on inspection, we have not been able to collect enough information to rate against one of the other ratings: outstanding, good, requires improvement or inadequate. Charts in our data appendix visualise the proportion of all active services with a current rating of outstanding, good, requires improvement or inadequate. The proportion of services where there was insufficient evidence to rate is provided in a note below the chart where applicable.

In our role as the independent regulator, we regularly publish our views on major quality issues in health and social care. This report includes data and insight from this work, including findings from the following reports:

• our provider collaboration review on the mental health care of children and young people during the pandemic
• our progress report on the use of restraint, seclusion and segregation in care services
• our report on safety, equity and engagement in maternity services
• the joint thematic inspection we supported with HM Inspectorate of Probation and other agencies of the criminal justice journey for individuals with mental health needs and disorders
• our CQC Insight 15: quality of ethnicity data recording for mental health services
• our programme of research to look at the impact and experiences of regulation on ethnic minority-led GP practices.

We have collected bespoke qualitative evidence to supplement our findings. Through this work, we have gathered views from our operations teams and subject matter experts on quality issues in particular sectors of health and social care and/or on particular aspects of our monitoring and regulatory approach, for example our monitoring of the DoLS. We are also informed by findings from our urgent and emergency care system inspection programme (published in system level inspection reports) and our internal evaluation of this programme.

We have used the data and insight that we have gained from our engagement with voluntary and community sector organisations, provider representatives, health and social care leaders, practitioners and people using services in health and social care.

This report is also informed by our wider horizon scanning activity. We have reviewed reports published by our stakeholders, drawn on national survey findings, and analysed publicly available datasets to supplement our understanding of the challenges facing health and social care today and the experiences of people using services. Where we have used data from other sources, these are referenced within the report.

Evidence in this report, alongside our Annual Report and Accounts, enables us to fulfil our legal duties to report on equality issues and on the operation of the DoLS.

Analytical findings have been corroborated, and in some cases supplemented, with expert input from our chief inspectors, colleagues in our Regulatory Leadership directorate, specialist advisers, analysts and subject matter experts to ensure that the report represents what we are seeing in our regulatory activity. Where we have used other data, we reference this in the report.