CQC Warns Health and Care Services are Straining at the Seams

The Care Quality Commission’s (CQC) annual assessment of the quality of health and social care in England, CQC State of Care, has been published and warns that whilst the health and care system is currently managing to deliver safe care, it is under threat as the system struggles with complex new types of demand, access and costs.

As at 31 July 2017:

  • 78% of adult social care services were rated good (71% were rated good at 31 July 2016), with 19% (2016: 26%) rated as needing improvement.
  • 55% of NHS acute hospital core services (2016: 51%) were rated good with 37% (2016: 39%) rated as needing improvement.
  • 68% of NHS mental health core services (2016: 61%) were rated good with 24% (2016: 33%) rated as needing improvement.
  • 89% of GP practices (2016: 83%) were rated good with 6% (2016: 10%) rated as needing improvement.

While recognising improvements this year, 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 we re-inspected had deteriorated, and only 2% of re-inspected GP practices deteriorated.

Whilst celebrating good and improving practice, the report also looks to the future and sounds the alarm bells.  The changing nature of demand – increasing numbers of older people who are physically frail, many with dementia, more people with long term complex conditions – 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.

Sir David Behan, Chief Executive of CQC, said “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. Many providers have used our inspection reports to improve, and we have seen improvements in safety in particular, although this area remains a big concern and focus for us. However, as people’s health and care needs change and become more complex, a model of care designed for the 20th century is at full stretch and struggling to cope with 21st century problems.”

“Last year, CQC warned that social care was ‘approaching tipping point’ – a point where deterioration in quality would outpace improvement and there would be a significant increase in people whose needs weren’t being met. We said this based on five pieces of evidence – on bed numbers, market fragility, unmet need and local authority funding and quality. This year, nursing home bed numbers are down, more contracts have been handed back and Age UK estimates that there is more unmet need. Helpfully, however, an extra £2bn has been made available through the Better Care Fund – and improvement in quality continues to outpace deterioration, although the rate of improvement has slowed.”

“The future of the social care system is one of the greatest unresolved public policy issues of our time – a long term sustainable solution is urgently required. The anticipated green paper on adult social care will provide the opportunity for Parliament, the public and professionals to consider how we can collectively develop an appropriately funded social care system that can meet people’s needs, now and in the future.”

“If services are to deliver consistently for people, there must be better coordination of care to create a sustainable and effective health and care system. 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. People should be able to expect consistent, personalised, safe care, and to be able to access that care when they need it – whether that’s delivered in an acute hospital, a nursing home, a community mental health hospital, a GP surgery or in their own home.”

In his comments, Peter Wyman, Chair of the CQC, signposted key indicators of excellent care “We often see personalised care at its best where there is strong leadership and a positive culture, and we have pointed to where a shared vision and outward-looking approach have been central to improvement – and to where providers have reached out to local communities and partners, involving patient and the public in shaping services, and collaborating with local groups. I have visited many providers myself over the course of the year and have been frequently impressed, not just by their hard work and commitment, but by their vision and innovation. We have seen examples of services working together – often harnessing new innovations and technology, including collaborating to share data – to transform care around people’s needs, with positive results on outcomes, access and people’s experience.”


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