CQC finds “gridlocked” health and care system is leading to people’s deteriorating access to care
The Care Quality Commission (CQC), the independent regulator of health and social care in England, has stated that the health and care system is “gridlocked” and unable to operate effectively in its latest annual report.
Today the CQC published its annual assessment of the state of health and social care in England looking at the quality of care over the past year.
The assessment was based on CQC’s inspection activity, information received from the public and those who deliver care alongside other evidence.
According to the report, most people are still receiving good care when they can access it – too often, however, people are not able to access the care they need. Capacity in adult social care has reduced and unmet need has increased.
Only two in five people are able to leave hospital when they are ready to do so, contributing to record-breaking waits in emergency departments following a decision to admit, and dangerous ambulance handover delays.
As part of work that included a series of coordinated inspections across the urgent and emergency care pathway in 10 Integrated Care Systems (ICSs), CQC convened a group of 250 health and care leaders – they described the system they work in as ‘in crisis’ and shared their fears that the risk of people coming to harm represents a worrying new status quo.
Its findings were that health and care staff want to provide good, safe care but are struggling to do so in a gridlocked system. This is reflected in growing public dissatisfaction with health and care services – which is mirrored in staff dissatisfaction.
More staff than ever before, it found, are leaving health and social care and providers are finding it increasingly challenging to recruit, resulting in alarmingly high vacancy rates which have a direct impact on people’s care.
Without action now, the report found, staff retention will continue to decline across health and care, increasing pressure across the system and leading to worse outcomes for people. Services will be further stretched, and people will be at greater risk of harm as staff try to deal with the consequences of a lack of access to community services, including adult social care.
The assessment found that this will be especially visible in areas of higher economic deprivation where access to care outside hospitals is most under pressure. In addition, more people will be forced out of the labour market either through ill health or because they are supporting family members who need care.
Better quality data and increased data sharing are critical not only to planning for people’s care needs but to understanding and tackling inequalities in people’s experience of and access to care, the report found. CQC’s work across local areas has highlighted that the current recording of demographic data, especially on ethnicity and disability, is not good enough.
The report states that workforce shortages across all sectors need to be addressed through innovative initiatives that look to the future, with a focus on shaping more flexible workforce models that help local systems meet the needs of people.
In adult social care, where workforce shortages are particularly acute, there needs to be increased funding and support for ICSs so they can own and deliver a properly funded workforce plan that recognises the adult social care workforce crisis as a national issue and ensures that pay and rewards attract and retain staff.
Ian Trenholm, Chief Executive of CQC, commented: “The fact is that it’s hard for health and care staff to deliver good care in a gridlocked system. There are no quick fixes, but there are steps to be taken now on planning, investment and workforce that will help to avoid continuing deterioration in people’s access to and experience of care.
“By working together to address the issues that lie behind the gridlock, we can create conditions that mean that next year, more people can access good, safe health and social care – delivered by a better supported workforce who have more reason to be optimistic about the future.”
Kate Terroni, Chief Inspector of Adult Social Care, Integrated Care and Interim Chief Operating Officer, added: “The money announced by Government to help speed up the discharge of people from hospital when they are medically fit to leave, as well as to retain and recruit more care workers is welcome – but there needs to be more focus on long-term planning and investment rather than short-term sticking plasters.
“With 165,000 vacancies in adult social care, there needs to be a real step change in thinking about how to attract and retain staff, with better pay, rewards and training linked to career progression. If this doesn’t happen, people will be at increased risk of harm.”
Responding to the Care Quality Commission’s (CQC’s) annual assessment of the state of health and social care, Matthew Taylor chief executive of the NHS Confederation, said: “The safety and quality concerns the CQC has laid bare in its annual report are the other side of the coin of when health and care services are not given the long-term funding and support they need to deliver for their local communities.”
He went on to explain that the 42 integrated care systems have the potential to drive forward improvements alongside providers but they are being “collectively held back” by the government’s refusal to acknowledge the scale of the workforce and funding challenges and to provide adequate support.
Sarah McClinton, President of The Association of Directors of Adults Social Services (ADASS) charity, said: “Reform is about more than not having to sell your home to pay for care, it is about providing more care at home, better pay for the workforce, increasing support for carers, and supporting people to recover after spending time in hospital.
“It is about something fundamentally different, not more of the same. Rather than talking about delaying reform, we should be accelerating it because improving social care will benefit us all.”
Commenting on the CQC’s State of Care report, Louise Ansari, National Director at Healthwatch England said: “Feelings of frustration and confusion about how to access care are starting to affect the public’s confidence that the NHS will be there for them when they need it.
“The barriers to accessing timely care can put people’s lives at risk and widen health inequalities, with disabled people and those lower incomes, being particularly affected.
“People really appreciate the care they get and the hard work of staff, but we need to make sure that our health and care services are supported so that everyone who needs care can access it as quickly as possible and in a way that meets their needs.”
