Adult social care ‘approaching tipping point’, warns CQC

Most health and adult social care services in England are providing people with safe, high quality and compassionate care – but with pressures rising on demand, access and cost, the Care Quality Commission is concerned about how long this can last.

In its annual assessment of the quality of health and adult social care in England, the CQC has found that despite challenging circumstances, as at 31 July 2016:

  • 71% of the adult social care services that CQC had inspected were rated ‘good’ and 1% were ‘outstanding’;
  • 83% of the GP practices inspected were ‘good’ and 4% were ‘outstanding’; and
  • 51% of the core services provided by NHS acute hospital trusts were ‘good’ and 5% were ‘outstanding’.

However, some people still received very poor care; 2% of adult social care services, 3% of GP practices and 5% of hospital core services were rated ‘inadequate’.

CQC has raised concerns that the sustainability of the adult social care market is approaching a tipping point. This view is based on the evidence of inspections, information received through CQC’s market oversight function, and a variety of external data.

  • Although three quarters of adult social care was initially rated ‘inadequate’ improved following re-inspection, nearly a quarter of re-inspected services were not able to improve their ratings. Half of services rated as ‘requires improvement’ that were re-inspected (904 out of 1,850) had no change to their rating. In 153 cases we found that the care had become inadequate.
  • CQC data shows that a five-year period of steady increase in the number of nursing home beds – going from 205,000 beds in 2009 to 224,000 beds in March 2015 – has now stalled, with numbers remaining static since that time.
  • Already CQC has seen examples of providers starting to hand back contracts as being undeliverable; local authorities warn of more to come. This is due to pressures on fees that funders of care are able or willing to pay, and cost pressures that include the impact of the national living wage (introduced in April 2016).
  • In 2015, Age UK estimated that more than a million older people in England were living with unmet social care needs (such as not receiving assistance with bathing and dressing); a rise from 800,000 in 2010.
  • The number of older people receiving local authority-funded social care fell 26% from more than 1.1 million in 2009 to around 850,000 in 2013/14. Also, 81% of local authorities have reduced their real-term spending on social care for older people over the last five years.

The fragility of the adult social care market is now beginning to impact both on the people who rely on these services and on the performance of NHS care, says the CQC. The combination of a growing and ageing population, more people with long-term conditions, and a challenging economic climate means greater demand on services and more problems for people in accessing care.

david-behan-cqcDavid Behan (left), chief executive of the Care Quality Commission, said: “The good news is that, despite challenging circumstances, most people are still getting high quality care and there are encouraging levels of improvement taking place. This is something to celebrate. However, there continues to be wide variation in quality, some providers are struggling to improve and there is emerging evidence of deterioration in quality.

“We are becoming concerned about the fragility of the adult social care market, with evidence suggesting that it might be approaching a ‘tipping point’. The combination of a growing, ageing population, more people with long-term conditions and a challenging financial climate means increased need but reduced access. The result is that some people are not getting the help they need – which in turn creates problems in other parts of the health and care system, such as overstretched A&E departments or delays in people leaving hospital.

“Unless the health and social care system finds a better way to work together, I have no doubt that next year there will be more people whose needs aren’t meet, less improvement and more deterioration.”


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