The report looks at the quality of care in our health and social care system over the past year. CQC’s assessment this year is that “The system has not collapsed – but the system is composed of individuals, both those who deliver and receive care, and the toll taken on many of these individuals has been heavy”.
Unsurprisingly the report highlights the workforce challenges, with staff being exhausted and depleted after a difficult 18 months. In particular, CQC notes the real struggle within social care to retain staff with staff vacancy rates having increased steadily from 6% in April 2021 to 10.2% in September 2021. With the difficulty of recruiting nurses, more and more providers are closing their nursing care homes. CQC states that if social care funding is to have any impact, it must be on developing a clearly defined career pathway for social care staff, which is linked to training and consistent investment and better pay. Otherwise staffing problems will reduce capacity and choice, and poorer quality of care will result. The overall effect will ripple into the wider health and care system creating a risk of a “tsunami of unmet need”.
Some other key highlights from the report are:
People’s experiences of care
CQC states the pandemic meant that people have struggled to access care or not sought care, though when people were able to access care, they were positive about it. Unfortunately, the pandemic has increased the challenges faced by people with learning disabilities, and exposed and exacerbated inequalities that people from some groups face in accessing care. There is a rising demand in mental health services, particularly for children.
Flexibility to respond to the pandemic
The NHS was able to increase its critical care capacity during the pandemic though this put extra pressure on staff. After the initial prioritisation of urgent care during the pandemic, there has been a push to get other services back in-line with pre-pandemic levels, though there is still a huge backlog. CQC has “serious” concerns about ambulance handover delays at hospitals, which is putting patients at risk.
Ongoing quality concerns
Closed cultures in a small number of high-risk mental health services is concerning, an issue made worse by the pandemic due to a lack of visitors, and staffing/management pressures. Improvements in maternity care are far too slow with continued concerns around the skill sets of staff and concerns as to whether there is learning taking place from adverse incidents. There are also extensive delays in authorising DoLS, meaning individuals are being deprived of their liberty for longer than necessary.
Challenges for systems
CQC undertook a number of Provider Collaboration reviews over the past year. This showed that collaborative working was varied across the local systems, and there was a lack of integration of adult social care providers in system-level planning and decision-making. Tackling inequalities was not a priority in these systems, though the issues were understood. Workforce planning for local systems is a priority and recruitment and staff retention continue to be “severe problems”.
There are many stark warnings within the report and it is clear that all providers of services within the system are facing huge challenges and pressures as they move into the winter. The staffing crisis in particular is a theme that permeates the report. To that end, these messages and warnings are somewhat at odds with the Government’s recent assurance that the health and social care system can cope in the coming year.
The full report can be read here: State of Care | Care Quality Commission (cqc.org.uk)
If you would like to discuss this topic in more detail, please contact Siwan Griffiths, Partner.