CQC chief warns of ‘tipping point’ for social care

The watchdog’s latest report shows 8% of care services were downgraded from a ‘requires improvement’ rating to ‘inadequate’ when re-inspected

Almost half (49%) of adult care services rated ‘requires improvement’ by the Care Quality Commission failed to achieve a higher rating at re-inspection, the watchdog has said.

A further 8% of services had deteriorated and were downgraded to an ‘inadequate’ rating.

The findings come from the CQC’s annual report on the state of health and care services in England. Of the 1850 services re-inspected in 2015-16, 904 had no change to their ‘requires improvement’ rating, 153 became ‘inadequate’, and the remaining 793 were able to improve.

Improvements were more widespread for ‘inadequate’ services, with 76% achieving a higher rating at re-inspection (23% jumped from ‘inadequate’ to ‘good’).

Speaking at the launch of the report, CQC chief David Behan, said: “It is hard to improve services that are struggling. It is not just about money – it is about good leadership, collaborating with others, and the ability to learn when things go wrong. In the services we re-inspected in adult social care, some of those characteristics weren’t there.”

‘Flagging the risk’

Behan added that the failure of services to make improvements quickly enough was one of five factors that suggested the adult social care market was “approaching a tipping point”.

The other four factors, which are supported by evidence from the CQC’s inspections and market oversight data, as well as a variety of external sources, are:

  • Residential and domiciliary care services are starting to hand back “undeliverable” contracts to local authorities due to cost pressures.
  • The steady increase in nursing home beds – from 205,000 beds in 2009 to 224,000 in March 2015, has now stalled, with numbers remaining static since that time.
  • The increase in the number of people living with unmet social care needs – Age UK estimates this has risen from 800,000 in 2010 to over a million in 2015.
  • The decline in the numbers of older people receiving local authority-funded social care, which has fallen by 26% since 2009.

Behan said: “I have worked in health and social care for 38 years and I cannot recall a time where those five factors have occurred together.

“We do not know when this tipping point is going to happen but if we did not flag this risk to sustainability in the future we would be failing in our responsibilities.”

The fragility of the adult social care system is also now beginning to impact on the performance of NHS care, the report warned. It said the increase in A&E attendances, emergency admissions, and delayed discharges were all directly linked to social care pressures.

Behan added: “While there are no easy answers or quick fixes, what distinguishes many of the good and outstanding services is the way they work with others – hospitals working with GPs; GPs working with social care, and all providers working with people who use services.

“Unless the health and social care system finds a better way to work together, I have no doubt that next year there will be more unmet need, less improvement and more deterioration.”

‘Poor safety and leadership’

The CQC had inspected more than 16,000 care services by 31 July 2016. Of these, 71% were rated ‘good’, 1% ‘outstanding’, 26% ‘requires improvement’ and 2% ‘inadequate’.

Services continued to perform best at being ‘caring’, with nine out of 10 providers receiving a ‘good’ or ‘outstanding’ rating for this area of the regulator’s inspection criteria.

Ratings for safety and leadership were comparatively lower, with 3% of services rated ‘inadequate’ for safety and 3% receiving an ‘inadequate’ rating for leadership.

The report said these low ratings were “concerning” and had resulted in people not getting the right medicine or staff not having time to care for people properly. It highlighted the prosecution of a care home owner and its former manager in September 2016, who were fined £50,000 after admitting they failed to provide safe care. Behan said at the report launch that the watchdog was in the process of bringing a further 14 prosecutions against care services.

‘Brexit uncertainty’

The report flagged the ongoing recruitment and retention issues in the sector and pointed to the uncertainty surrounding the status of EU workers – who make up an estimated 7% of the adult social care workforce – and to the extent they will be affected by the UK’s vote to leave the European Union. The recruitment of nurses remains a “significant concern”, it said.

Margaret Willcox, vice-president of the Association of Directors of Adult Social Services, said: “We have been arguing for some time now that adult social care needs to be given adequate recognition and resourcing.

“Services are being cut and the outlook for future care is bleak. We are at a tipping point where social care is in jeopardy and unless the government addresses the underfunding of the sector, there will be worrying consequences for the care market, the NHS and, most importantly, for older and disabled people, their families and carers.”

A Department of Health spokesperson said that the report showed that most NHS services, social care providers and GP practices inspected by the CQC were rated ‘good’ or better and “improvement is taking place all over the country”.

“The government is investing £10 billion to fund [the NHS’s[ own plan for the future, and crucially is ensuring that the amount of money available to local authorities for social care is rising in future years of the parliament, reaching up to £3.5 billion extra by 2020.”

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6 Responses to CQC chief warns of ‘tipping point’ for social care

  1. A Man Called Horse October 13, 2016 at 11:22 am #

    The facts are stark. Austerity for the 99% and riches for the 1% The Government have few concerns that the cuts to LA Budgets have reduces service provision. Local Authorities cannot pay more to home care providers services while their budgets are being cut by 40% What this means that many more providers who are legally required to meet the law on minimum wage will be squeezed with some providers opting out of LA contracts and providing only private care to more wealthy citizens. The current situation is that people sit in hospital beds and cannot be discharged as the home care needed is not available. The Government have also forced LAs to outsource what home care they did have and in the process cut the terms and conditions of staff employed with many now on zero hour contracts. All of this was based upon tory ideology, dogma. What we now have is elderly people being left to survive in a kind of game of thrones survival of the fittest. Meanwhile Austerity continues up until at least 2020 and possibly beyond. Stop voting for this rubbish is my advice to all who are reading.

    • Lucy October 17, 2016 at 4:37 pm #

      As a frontline social worker I completely agree with the above comments. The impact of austerity on social work practice is also that an already immensely stressful job has become so much more stressful. Fewer social workers employed, increased and more complex caseloads and pressures.Social work is no longer about working with individuals and families to achieve positive outcomes and change, but is about being a tool and agent for councils to save money at all costs and implement austerity. As a social worker it is soul destroying to have to go to so called ‘panels’ frequently and have to argue for relatively low cost packages of care, it is depressing and stressful to have to work in an oppressive environment where senior managers are only interested in saving money. It is stressful to work in a way that does not allow you to do your job properly and feel that you have to constantly just do enough to get by because you are continually allocated new cases weekly, have to do duty, pick up safeguarding cases, complete DOLs assessments, supervise unqualified members of the team and all within an organisation that does not care if your registration is at risk (because you just do not have the physical time to do all that is asked and required by law of you) and if you do say that you are struggling then it is individualised and suggestions made that it is you and somehow your fault. There has never been a more stressful time to be social worker.

  2. Hospital social worker October 16, 2016 at 4:13 pm #

    I see this in my direct practice as a hospital social worker and it saddens me to see the lack of beds available with a recent news report stating approx 50 care homes in the north west rated as inadequate. The system needs to change. End privatisation. It’s not sustainable.

  3. Paul October 17, 2016 at 11:47 am #

    As care training providers we get a unique view of the state of care. Recent issues. Unable to demonstrate recovery position as carpet smelled of urine, I was asked to make a days safeguarding training 30 minutes long, We take our own slings when doing manual handling training as the ones the staff use are usually damaged or dirty. It getting worse out there. But what do they expect when most training now is in front of a DVD.

  4. Fred October 17, 2016 at 12:12 pm #

    The difference in Tory treatment of the bankers who caused the misery (but of course donate millions to the Tory Party) and older and more vulnerable people is quite stark.

    For the rich – a tax cut and tax breaks for the Eton and Rugby school fees.

    For the Chronically sick and disabled – a 40% cut to local government resourcing and consequent neglect and misery.

  5. Gerald October 17, 2016 at 1:59 pm #

    Most of these cuts , which began in 1993 were imposed by Labour controlled Councils and subsequently increased with the cooperation of the NHS making previously “Free” NHS care means tested .