This year’s State of Care report from the Care Quality Commission 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.
But future quality is precarious as the system struggles with complex new types of demand, access and cost.
The CQC’s annual assessment of the quality of health and social care in England contains much that is encouraging. As at 31 July, 78% of adult social care services were rated good (71% were rated good at 31 July 2016) as were 55% of NHS acute hospital core services (2016: 51%); 68% of NHS mental health core services (2016: 61%) and 89% of GP practices (2016: 83%).
Two per cent of adult social care services, are rated outstanding. Many services that were originally rated as inadequate have used the findings of CQC’s inspection reports to make the necessary changes and have improved.
However, the changing nature of demand – increasingly numbers of older people who are physically frail, many with dementia, more people with long term complex conditions – is placing unprecedented pressure on the system.
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. Estimates show that one in eight older people are not receiving the help they need.
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. There is also much care that needs to improve – 19% (2016: 26%) of adult social care services.
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. 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.
“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.”