One in 10 adult care services is delivering ‘unsafe care’, finds watchdog

One in 10 adult social care services is falling short on standards of safety despite most providing good or outstanding care, the Care Quality Commission (CQC) has found.

The watchdog’s State of Care report for 2014-15 said providers’ inability to learn from mistakes, a lack of adequately-skilled staff and ineffective risk management systems were driving the ‘inadequate’ ratings for safety.

The report cited safety as the greatest concern in the sector, with a third of adult care services also rated ‘requires improvement’ in this area.

‘Older people at risk’

Safety is one of five key lines of enquiry introduced under the CQC’s new inspection approach, which took effect in October 2014. Services are rated on each of the five areas and also given an overall rating.

Services were generally performing well in the other four areas, with 85% receiving a ‘good’ or ‘outstanding’ rating for caring, 68% for responsiveness, 63% for effectiveness and 61% for leadership. Overall, of services rated up to 31 May 2015, 1% was outstanding, 59% good, 33% requires improvement and 7% inadequate.

But despite this overall picture, the report warned that some people are at risk of receiving ‘consistently poorer care’ because of who they are.

For example, the tightening of access to care by councils has hit older people hardest.

The number of adults aged 65 and over who accessed council-funded adult social care dropped by more than 42,300 in 2013-14 – an almost 5% reduction when compared with the previous year. The equivalent reduction for adults aged 18-64 was 2.9%.

‘Poor nursing care’

In keeping with the trend of previous years, the watchdog found nursing homes to be performing less well than other adult social care services. One in 10 was rated ‘inadequate’ and less than half (46%) received a ‘good’ or ‘outstanding’ rating.

The retention and recruitment of nurses also continued to be an issue, with vacancy rates as high as 20% in domiciliary care and 11% in residential care. The report highlighted the need for better recruitment practices, but acknowledged the struggle providers faced in competing with the NHS to retain their nursing staff.

Nursing was placed on the list of shortage occupations by the Home Office earlier this week, following increasing concerns from NHS providers about a national shortage. This will see immigration controls on nurses working in the UK relaxed with immediate effect, pending a review by the migration advisory committee.

Nurses from non-EU countries wishing to work in the UK will no longer face having their visas rejected, while those who have been working here for six years or more and who earn less than £35,000 a year will not have to leave the country from April 2016.

Martin Green, chief executive of care provider organisation Care England, said the announcement was an “extremely positive” one for the sector.

The two highest performing sectors were community social care services, which include Shared Lives schemes, and domiciliary care agencies, with both achieving 67% ‘good’ ratings and 1% ‘outstanding’.

‘Financial instability’

The State of Care report also recognised the increasing financial pressures the sector was facing, with significant cuts to council budgets, the increasing complexity of people’s needs and high vacancy rates all playing a part in providers’ ability to deliver care.

But CQC chief executive David Behan added that the wide variation in care observed by inspectors was not just about the money.

“Good leaders are what make the difference – leaders who engage staff and people who use services and create a culture of continuous quality improvement,” he said.

“What is very clear is that isolated working and incremental changes are not going to be enough to meet the challenges ahead.”

Martin Green added: “The key message of the CQC’s report is that all the strides that have been made in successive years to improve quality are now being placed in jeopardy by underfunding. The sector is increasingly fragile and on the cusp of viability, and if the government does not heed the warnings of the independent regulator there will be a crisis in care and hundreds of thousands of people will be denied services.”