This year’s State of Care Report from the CQC shows that most people receiving care are still getting good care – but there are significant issues accessing care, with one in seven older people having unmet care needs.
The Care Quality Commission’s (CQC) annual assessment of the quality of health and social care in England shows that overall, quality has been largely maintained, and in some cases improved, from last year. This is despite continuing challenges around demand and funding, coupled with significant workforce pressures as all sectors struggle to recruit and retain staff. The efforts of staff, leaders and carers to ensure that people continue to receive good, safe care despite these challenges has been recognised and applauded in the report.
Key Challenges For The Care System
The report concludes that people’s experience of care varies depending on where they live; and that these experiences are often determined by how well different parts of local system work together.
Ineffective collaboration between local health and care services can result in people not being able to access the care and support services in the community that would avoid unnecessary admissions to hospital, which in turn leads to increased demand for acute services.
The most visible impact of this is the pressure on emergency departments as demand continues to rise, with July 2018 seeing the highest number of attendances on record.
Many people have more difficulty accessing support or to have to travel unreasonable distances to get it. For example, inappropriate out of area mental health placements – with some people being placed hundreds of miles from their homes – vary considerably by region. And the CQC’s review of children and young people’s mental health services found that some children and young people were ‘at crisis point’ before they got the specialist care and support they needed, with average waiting times varying significantly according to local processes, systems and targets.
Posing a threat to effective collaboration between health and social care is the continued fragility of the adult social care market, with providers closing or ceasing to trade and contracts being handed back to local authorities. Unmet need continues to rise, with Age UK estimating that 1.4 million older people do not have access to the care and support they need. In two years, the number of older people living with an unmet care need has risen by almost 20%, to nearly one in seven older people. While the government made a welcome NHS funding announcement in June 2018, the impact of this, and last week’s short-term crisis funding for adult social care, risks being undermined by the lack of a long-term funding solution for social care.
Peter Wyman, Chair of the Care Quality Commission said “The fact that quality has been broadly maintained in the face of enormous challenges on demand, funding and workforce is a huge testament to staff and leaders.
“But we cannot ignore the fact that not everyone is getting good care. Safety remains a real concern: although there have been some small improvements 40% of NHS acute hospitals’ core services and 37% of NHS mental health trusts’ core services were rated as requires improvement on safety. All providers are facing similar challenges – in acute hospitals, the pressure on emergency departments is especially visible – but while many are responding in a way that maintains quality of care, some are not.
“Our other big concern is the fragility of the adult social care market. Two years ago, we warned that social care was ‘approaching a tipping point’ – as unmet need continues to rise, this tipping point has already been reached for some people who are not getting the good quality care they need. It is increasingly clear without a long-term funding settlement for adult social care, the additional funding for the NHS will be spent treating people with complex conditions for whom care in the community would have been more effective both in terms of their health and wellbeing and use of public money.”