State of Care 2017 highlights precarious future

October 10, 2017

The Care Quality Commission’s State of Care 2017 report 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. However, it says that future quality is precarious as the system struggles with complex new types of demand, access and cost.

The Care Quality Commission’s (CQC) annual assessment of the quality of health and social care in England contains much that is encouraging. As at 31st July 2017:

  • 78% of adult social care services were rated Good (71% were rated Good at 31st July 2016).
  • 55% of NHS acute hospital core services were rated Good (2016: 51%).
  • 68% of NHS mental health core services were rated Good (2016: 61%).
  • 89% of GP practices were rated Good (2016: 83%).

From this analysis, it is clear that the quality of care has been maintained. Two percent of adult social care services, 6% of NHS acute hospital and mental health core services, and 4% of GP practices 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 – increasing 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 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; 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; 37% (2016: 39%) of NHS acute core services; 24% (2016: 33%) of NHS mental health core services; and 6% (2016: 10%) of GP practices were rated as Requires Improvement.

The State of Care 2017 report also found that:

  • 82% of adult social care services originally rated as Inadequate and re-inspected (606 out of 740) improved their rating.
  • 12 out of the 15 hospitals originally rated as Inadequate and re-inspected improved.
  • All of the nine mental health services (NHS trusts or independent hospitals) originally rated as Inadequate and re-inspected improved their rating.
  • 80% of GP practices originally rated as Inadequate and re-inspected (156 out of 196) improved.

While recognising improvements, there is also deterioration that must be addressed. Looking at providers rated Good overall the first time CQC inspected, the majority have remained Good. But of the services that were re-inspected, 26% of mental health services and 23% of adult social care services originally rated Good dropped at least one rating. Also, two out of the 11 NHS acute hospitals that CQC re-inspected had deteriorated, and only 2% of re-inspected GP practices deteriorated.

Since CQC introduced its new approach to inspection and rating, there has been a clear improvement overall in safety across all of the sectors regulated and rated. Where CQC has seen improvements, providers have good monitoring that gives staff a clear, accurate and current picture, which allows risk to be assessed in real time, clear systems and governance in place, which enable learning from incidents and a positive culture where staff are encouraged to raise concerns.

Despite this progress, there remain many opportunities for further improvement and CQC says that many providers could and should do more; safety remains CQC’s key focus and biggest concern across all sectors. As at 31st July 2017, the figures for services rated as Inadequate for safety were:

  • 5% (31st July 2016: 6%) of acute hospital core services.
  • 3% (2016: 7%) of core services in NHS mental health trusts.
  • 2% (2016: 3%) of adult social care services.
  • 2% (2016: 2%) of GP practices.

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.

Responding to the report, Niall Dickson, Chief Executive of the NHS Confederation did not hold back with his thoughts, 'It would be a tragedy if the NHS’s 70th birthday was remembered as the year England’s care system collapsed, but today’s report reveals real concerns that mental health and social care services are not sustainable. Contracts are being handed back leaving more individuals at risk.

'Let no-one misunderstand what is being said here – the health and care system is managing well, with some improvements in safety, but its future is precarious. And one in eight older people are not getting the help they need.

'CQC has the support and confidence of government yet this message is not a comforting one – once again with herculean effort, leaders and those on the frontline have delivered safe services to millions but the pressures are taking their toll.

'Today’s report is unequivocal – the quality of services is in a fragile state as the system strains to treat and support more older people with complex conditions. There are fewer nursing home beds and homecare contracts are being handed back because there is not enough money to pay for the care that is needed.

'Of course, as the report acknowledges, there is more that local services can do to improve co-ordination and the way services are organised, but the inescapable conclusion has to be that without further government funding, today’s perilous state will become tomorrow’s tragedy,

'As CQC has pointed out, this is one of the major unresolved public policy issues of our time. It is time government and indeed all the political class woke up to this challenge and accept that if social care goes down, we all go down.'

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