Two-thirds of hospitals are offering substandard care, according to the NHS regulator, which also warns that pressure to cut costs could lead to a further worsening of the health service in the coming years.

The Care Quality Commission also said that levels of safety are not good enough in almost three-quarters of hospitals, with one in eight being rated as inadequate.

In its annual report, the watchdog detailed examples including one hospital where A&E patients were kept on trolleys overnight in a portable unit and not properly assessed by a nurse; while in another, medicine was given despite the patient’s identity not being properly confirmed. In some care homes, residents either received their medication too late or were given too much of it, leading to overdoses.

Understaffing and money problems are already contributing to a situation where 65% of hospitals, mental health and ambulance services either require improvement or are providing inadequate care.Too many patients are already receiving care that is unacceptably poor, unsafe or highly variable in its quality, from staff who range from the exceptional to those who lack basic compassion, it adds.

In the report, England’s health and social care regulator raises concerns that patients could suffer as the service seeks to make the £22bn of efficiency savings by 2020 that NHS England has offered and health secretary Jeremy Hunt is pressing it hard to start delivering.

“The environment for health and social care will become even more challenging over the next few years,” it states. “Tensions will arise for providers about how to balance the pressures to increase efficiency with their need to improve or maintain the quality of their care”.

Painting a picture of care services under unprecedented strain from budget cuts, staff shortages and rising demand, the CQC report spells out its concerns that:

• While care at 1% of hospitals, mental health and ambulance services has been found to be outstanding and another 34% good, many more – 57% – require improvement and 8% are inadequate.

• One in eight hospitals inspected by the CQC – 13% – were found to be “inadequate” for safety and a further 61% require improvement, with some repeating the same mistakes over and over again and failing to learn from serious blunders.

• It is “of intense concern” that 7% of all the health and social care providers it had inspected until the end of May were deemed to be inadequate overall.

• There are worryingly wide variations in the standard of care provided and “many people continue to experience large differences in the quality of care they receive – both between different services from the same provider and between different providers”.

• The millions of people with mental health problems or long-term health conditions, and some minority ethnic groups, are more likely to experience poor care.

Personnel problems lie behind many of these findings, the CQC said. “Staffing is one driver of the ratings our inspectors have given for safety across all sectors ... We are conscious that there can be difficulties getting staffing right and that there are specific challenges in some sectors, such as ensuring sufficient nurses in adult social care, GPs in primary care and consultants in A&E.”

The findings on safety are a surprise, given the intense efforts across the NHS to improve safety since Robert Francis QC’s official report into the Mid Staffs scandal was published in early 2013.

David Behan, the CQC’s chief executive, admitted that, with both the NHS and social care services facing “challenging circumstances”, especially financially, “some providers ... are struggling to provide a high-quality service.”

The regulator risks angering ministers by highlighting how a 31% cut in local councils’ budgets under the coalition has led to a £4.6bn cut in spending on social care services, which many older and disabled people rely upon. It has forced councils to restrict care to those in greatest need and led to 400,000 fewer people receiving publicly-funded care than did so in 2009-10, it said. Doctors and NHS bosses have warned repeatedly that cuts to social care are leading to ever-greater pressure on the NHS, especially in A&E units.

“Today’s report lays bare the dilemma facing the NHS: how to maintain essential standards of quality and safety while grappling with squeezed finances and staffing problems,” said Nigel Edwards, chief executive of the Nuffield Trust health thinktank.

That even NHS trusts rated as “good” or “outstanding” were found to have too little staffing underlines the seriousness of the service’s increasing difficulty recruiting and retaining enough personnel, and “suggests that these problems are systemic across the whole hospital sector, as well as social care”, Edwards added.



Janet Morrison, chief executive of Independent Age, the older people’s charity, said: “It’s simply not good enough that two in five care providers and three in five hospitals rated so far are not up to scratch. And it’s deeply worrying that the independent watchdog found one in every eight hospitals and one in eight care providers to be unsafe.”

Hunt, who has made improving safety in the NHS his top priority in the three years he has been in office, said his ambition was still to make the NHS the world’s safest healthcare system. While much care is good, the enduring level of variation in the quality of care provided in different parts of England, and even by separate departments of the same hospital, is “unacceptable”, he said.

The new independent patient safety investigation service, modelled on the air accident investigation branch in the airline industry, will mean patients “benefit from a scrupulous approach to learning from mistakes in patient care”, he said.

GPs provide the best care, the CQC said. It rated 85% of surgeries as good or outstanding, although 11% required improvement and 4% were inadequate.

Overall, the majority of the 5,439 health and social care providers CQC inspectors have visited and rated have also been classed as good or outstanding.