In our annual State of Care publication, we shine a light on what we have seen through our annual regulatory activity. In adult social care, we have seen demand continuing to rise in an environment where staff vacancies remain at three times that of the wider job market. In homecare, vacancy rates are more than double that of care homes. Indications are that the end of new care worker visas is likely to put further pressure on recruitment. As well as deepening challenges for managers of care services, these workforce pressures have a real impact on the people receiving care.
In focus groups with CQC Experts by Experience, we heard how staff turnover can lead to uncertainty for people receiving homecare. ‘I don’t know who’s coming through the door, and if that’s in your own home and you’ve got strangers turning up all of the time, it’s not very nice for you.’ People also told our experts that they often receive rushed care, or that care workers are late due to staffing pressures. This impacts people’s health, wellbeing, dignity and independence in different ways, for example if staff are unable to give people their medicines on time or supervise mealtimes.
Issues with staffing are also highlighted in our inspections of care homes. For example, we inspected a care home in response to concerns regarding the safety and quality of care, where people and their relatives told us that there were not enough staff. One person told us, ‘Staff don’t get time to sit and chat… I get lonely.’ In this inspection, we also found staffing levels were not reviewed following incidents of concern or falls. We took urgent action to prevent the provider from taking further care packages without our agreement.
With the right intervention and commitment, failing services can improve. One care home improved from a rating of Requires improvement to Outstanding, partly by improving its governance. On the previous inspection, we found there were no systems and processes to assess, monitor and improve the quality and safety of care, and to maintain accurate and complete records. Care records were not always documented or kept up to date. But at our next inspection, the service was no longer in breach of the regulation as it had made improvements and embedded the appropriate governance systems.
This kind of improvement is highlighted in our report and can offer beneficial guidance for other services looking to improve. A positive and improvement-focused culture is vital. We inspected a care home for people with dementia and age-related frailties towards the end of 2024, which we rated Outstanding. Contributing to this rating was excellent leadership, which nurtured a very positive culture and ensured the staff team embraced their roles, and consistently prioritised people’s individual needs and preferences. They did this partly by matching the approaches, skills and strengths of staff to people’s individual needs.
Leaders promoted an inclusive environment where staff were encouraged to raise their viewpoints on the delivery of care and management practices and suggest improvements. For instance, a member of staff directly highlighted the staffing challenges in a particular area of the home to senior leaders. In response, leaders conducted a thorough review and analysis, ultimately increasing staffing levels to address the issue. Through State of Care, though the challenges the sector faces are laid bare, we can see examples of good practice and exceptional care across the country.
To read State of Care 2024/25, visit CQC’s website. Then, comment on this column or join the conversation to share your thoughts.
Mary Cridge is Director of Adult Social Care at CQC. Email: n[email protected] X: @CQCProf