The Care Quality Commission's new state of adult social care report finds that most services meet the ‘Mum Test’ but there is still too much poor care.
While the majority of services are safe and of a high quality and many are improving, the CQC says that too many people across England are living in care homes and receiving care and support in their own homes that is not good enough. Without a proper recognition of the importance of adult social care and a renewed commitment to quality, the numbers of people affected by poor care could increase and have a profound impact on their lives.
In its national report, The State of Adult Social Care Services 2014 to 2017, the CQC has found that over three-quarters of adult social care services are currently rated as Good (77%, 16,351) and 2% (353) are currently rated as Outstanding.
CQC has found that strong leaders – both at provider and registered manager levels – play a pivotal role in high-performing services, where a strong vision and person-centred values inspire staff, encouraging a culture of openness and transparency. Staff members are capable, confident and caring and are focused on supporting people to live the best lives they can.
However, CQC has found considerable variation with nearly a fifth (19%, 4,073) of services being rated as Requires Improvement and 2% (343) as Inadequate.
This is the first time that such focused analysis on a national scale has been possible following the formal introduction of CQC’s new regulatory regime for adult social care in October 2014. Since then, CQC has carried out over 33,000 inspections of around 24,000 different services – many more than once.
CQC found the adult social care sector performed best in how ‘caring’ its services were, with 92% being rated as Good and 3% as Outstanding in this key question. In these services, CQC found staff building meaningful relationships with the people who they care for over time and treating them with compassion, kindness, dignity and respect.
Safety is where CQC has found its greatest concerns, with 23% of services being rated as Requires Improvement and 2% as Inadequate in this key question. Issues uncovered by CQC include ineffective systems and processes for managing medicines or determining staffing levels, which can result in people not getting their prescribed medicines, call bells not being answered, and home visits being rushed or missed.
Of the 686 services that were originally rated as Inadequate and have been re-inspected, more than four in five (81%, 553) improved their overall rating. However, this does still mean that nearly a fifth of services have not improved and further action is required.
CQC has not seen the same rate of improvement in services that were rated as Requires Improvement initially, where only 56% of the services eventually improved to Good, with others failing to improve and some deteriorating.
Worryingly, 26% of the services that were first rated as Good and have been re-inspected have deteriorated. While these are a small proportion of services that were originally rated as Good, it shows that providers cannot always sustain this level of good practice within their services and that as a whole; the sector continues to be fragile at a time when more people are expected to need its services.
VODG Chief Executive, Dr Rhidian Hughes commented on the report, saying, 'This report provides a welcome, authoritative, contribution on the state of adult social care. At a time when the sector is being financially pushed to the brink, CQC’s assessments on the quality of care have never been so important.
'The vast majority of services are Good and this is a great credit to the sector’s workforce. But there remains considerable variation in quality across the market and it is unacceptable that some people find themselves exposed to poor and inadequate services. VODG is encouraging providers and commissioners to use CQC’s evidence to inform a continued step up in quality, and to share what works well across the sector.'
Professor Martin Green OBE, Chief Executive of Care England said, 'The report indicates that although progress has occurred there is much to be done in order to ensure that all providers are in a position to provide the best quality care; getting to grips with the fees from local authorities and CCGs is key to this objective. Care England welcomes the report and the intelligence it provides will ensure CQC and providers can work to see a social care sector that can achieve the high ambitions it sets itself for good quality and personalised care.
'This sector is still at a tipping point. In order for this to be alleviated the resource, including the newly-pledged money from the Government, needs to be delivered to the frontline. This is not always happening and action must be taken to address this by Government.'