Most people still getting good care – but health and care system is ‘straining at the seams'

This year’s State of Care report from Care Quality Commission’s (CQC) shows that, thanks to the efforts of staff and leaders, the quality of health and social care has been maintained despite very real challenges and the majority of people are getting good, safe care.

It shows that as of 31 July 2017, most services had improved from the year before: 78% of adult social care services were rated good as were 55% of NHS acute hospital core services, 68% of NHS mental health core services and 89% of GP practices.

Despite this, the report warns that future quality is precarious due to unprecedented pressures on the system, such as with complex new types of demand – increasingly numbers of older people who are physically frail, many with dementia, more people with long term complex conditions – and access and cost.

In acute hospitals, this means more people waiting over four hours at A&E; more planned operations cancelled, and people waiting longer for treatment. In adult social care, the number of beds in nursing homes has decreased across most of England and domiciliary care contracts are being handed back to councils because providers say the funding is insufficient to meet people’s needs.

Additionally, a very small minority of care was found to be failing people – between 1% and 3% of providers across the services CQC regulates were rated inadequate. CQC will use a targeted approach to work with these providers in order to drive improvement, and to take action to protect people where necessary.

Sir David Behan, Chief Executive of CQC, said: “The fact that the quality of care has been maintained in the toughest climate that most can remember is testament to the efforts of frontline staff, managers and leaders. Many providers have used our inspection reports to improve, and we have seen improvements in safety in particular, although this area remains a big concern and focus for us. However, as people’s health and care needs change and become more complex, a model of care designed for the 20th century is at full stretch and struggling to cope with 21st century problems.

“The impact of this on people is particularly evident where sectors come together – or fail to come together, as the complex patchwork of health and social care strains at the seams.

“In children and young people’s mental health services, for example, a system where care is planned, funded, commissioned and provided by different organisations can result a child’s mental health reaching crisis point before they get the help they need. The forthcoming green paper on child and adolescent mental health and the Mental Health Act review provide an opportunity to address this acknowledged problem.

“Last year, CQC warned that social care was ‘approaching tipping point’ – a point where deterioration in quality would outpace improvement and there would be a significant increase in people whose needs weren’t being met. We said this based on five pieces of evidence – on bed numbers, market fragility, unmet need and local authority funding and quality. This year, nursing home bed numbers are down, more contracts have been handed back and Age UK estimates that there is more unmet need. Helpfully, however, an extra £2bn has been made available through the Better Care Fund - and improvement in quality continues to outpace deterioration, although the rate of improvement has slowed.

“The future of the social care system is one of the greatest unresolved public policy issues of our time – a long term sustainable solution is urgently required. The anticipated green paper on adult social care will provide the opportunity for Parliament, the public and professionals to consider how we can collectively develop an appropriately funded social care system that can meet people’s needs, now and in the future.

“If services are to deliver consistently for people, there must be better coordination of care to create a sustainable and effective health and care system. Staff and leaders can’t work any harder; the answer must be to work more collaboratively, not just between sectors but between agencies and professionals, supported and incentivised by the national health and care organisations.

"People should be able to expect consistent, personalised, safe care, and to be able to access that care when they need it – whether that’s delivered in an acute hospital, a nursing home, a community mental health hospital, a GP surgery or in their own home.”

Responding to the annual assessment Councillor Izzi Seccombe, Chairman of the Local Government Association’s Community Wellbeing Board, said: “It is encouraging that the vast majority of adult social care services were rated good, and that services have improved on last year, which is a massive achievement given the unprecedented pressures across the system.

“Social care faces a perfect storm, and the CQC report is yet another timely warning from a key part of the sector, of the need to resolve the short and long-term future of care as an urgent priority.

“It was pleasing to see that social care was such a prominent issue during the election campaign, and that the vast majority of MPs agree there needs to be a cross-party solution.

“The pre-election momentum must be maintained, and it is imperative that the Government urgently brings forward its consultation on how it will tackle the social care funding crisis.

"Everything must be on the table when it comes to discussing how we pay for the care people need, and who contributes.

“We have warned that despite the helpful one-off funding of £2 billion announced in the Spring Budget, social care faces an annual funding gap of £2.3 billion by 2020. Government must use the forthcoming Autumn Budget to set out how it plans to address this.”