The quality of social care and health care in England has been maintained even though “the entire system” is at full stretch, the Care Quality Commission (CQC) has said in its annual State of Care report.
It said the number of beds in nursing homes had “decreased across most of England” and domiciliary care contracts were being “handed back to councils because providers say the funding is insufficient to meet people’s needs”.
Despite this pressure, at the end of July 2017, 78% of adult social care services were rated ‘good’ by the watchdog, against 71% at the same point in 2016. For NHS mental health services the figures were 68% and 61% respectively.
The report also praised services for improving in response to unfavourable inspections. Among adult social care providers, 82% of previously ‘inadequate’ services inspected up to 31 July had improved, while 58% of those previously deemed ‘requiring improvement’ had done likewise.
“The fact that the quality of care has been maintained in the toughest climate that most can remember is testament to the efforts of frontline staff, managers and leaders,” said the CQC’s chief executive, David Behan.
Yet the positive headline figures concealed a “complex patchwork of health and social care” that “strains at the seams”, especially where services interface with one another, Behan warned, adding that better coordination of care was the only long-term solution.
“Staff and leaders can’t work any harder; the answer must be to work more collaboratively, not just between sectors but between agencies and professionals, supported and incentivised by the national health and care organisations,” Behan said.
‘No single tipping point’
After warning in last year’s State of Care report that the adult social care sector was approaching a “tipping point”, the CQC said that the overall picture remained “precarious” despite the extra £2bn made available by the government via the Better Care Fund. But it added that there were considerable differences from region to region.
“What is clear is that there is not one national picture for adult social care – the pressures are being felt at a local level and to different degrees,” the report said. “There is wide variation across the country in the quality of care [and] variation too in providers’ response to market conditions – in some parts of the country, the number of beds is rising; in others, it is falling.” It added that the proportion of people paying for their own care varied widely between authorities too.
“While in some areas, social care has moved further away from a tipping point, in other areas it has moved closer,” the report concluded.
Overall, though, the State of Care report found that the complexity of demand for health and social care services was continuing to rise, placing “unprecedented pressure” on the system. It noted that the number of people aged 85 or above in England is set to more than double over the next two decades, and that the numbers of people living with unmet care needs had risen to an estimated 1.2 million.
Moreover, it said, the total number of beds in nursing homes had dropped by almost 4,000 between March 2015 and March 2017, with some areas facing drops in capacity of almost 20%.
Local authority funded domiciliary care was continuing to dwindle, with significant churn taking place as providers entered and left the sector – in part because contracts were not paying enough to be viable. Despite a few bright spots, all areas of health and social care were continuing to face staff recruitment and retention challenges, with Brexit adding further uncertainty.
The report also highlighted the uncertainty in the adult social care sector over retrospective charges being levied for sleep-in shift wages, and the financial problems that delayed transfers of care were causing some councils.
The latter issue, the report said, was “introducing tension in the relationship between some local authorities and NHS trusts at a time when the focus should be on working together”.
Margaret Willcox, president of the Association of Directors of Adult Social Services (ADASS), said that despite the “dedication” of social care staff, the combination of challenges faced by the sector meant that it faced a “bleak future”.
“While the extra £2 billion funding for adult social care is welcome, this is only short-term,” Willcox added. “Without a long-term, sustainable solution for adult social care, there will be worrying consequences for the fragile care market, the NHS and, most importantly, for older and disabled people, their families and carers who need and deserve good, reliable and personal care.”
Willcox called on the government to bring forward its plans to consult on the future of adult social care, a process that health minister Philip Dunne said would take place “in due course”.
Dunne said that the CQC had “again recognised” that the vast majority of people receive good care.
But Stephen McCarthy, the England director at Action on Elder Abuse, said that the State of Care report painted a “deeply troubling picture of a sector slipping further into crisis, without any means of stopping it”. He added that the headline figures showed that the CQC’s inspection regime was also failing to make enough impact on “failing” care provision.
“Overall, more than one in five (22%) of adult social care services [are] not meeting public expectations, with thousands of our older people living in care circumstances that the law says are unacceptable,” McCarthy said. “This was the situation last year and so it continues – showing widespread failure across the sector but also with regulation itself.”