CQC’s State of Care Report was published on 29 October 2021. This article focuses on some of the issues CQC raises in the report around Adult Social Care (ASC).
The report declares that the pandemic has reinforced the vital role ASC plays for the many who rely on it. As a sector, “massive challenges” have been faced in keeping people safe and that, “most care providers that we have inspected have demonstrated that they have faced their challenges well” going the “extra mile” to support people in their care.
So what were some of CQC’s findings?
Quality and Safety
CQC reports that of the 5000 Infection, Prevention and Control (IPC) inspections conducted from Summer 2020, CQC was assured of full compliance in 69% of cases. There was a 4% increase between September 2020 and August 2021. The biggest improvement being in the admission processes to the service and other improved areas were in access to testing, shielding and social distancing and having up-to-date IPC policies.
It also reports that as of 31 July 2021, 80% of this sector’s services were rated Good, with 5% rated Outstanding,14% rated as Requires Improvement and 1% rated as Inadequate. These ratings have not changed from those reported on in last year’s report (the one exception being Requires Improvement which was at 15% last year). Drilling down further, 73% of nursing homes were rated Good compared to Community Care at 87%, Residential Care at 83% and Domiciliary Care at 83%.
Whether the above statistics are actually reflective of the current quality of care in services is debatable. A constant concern expressed by providers is the fact that they simply have not had a CQC inspection for some time (and certainly not since the beginning of the Pandemic). If they are not seen as a risk to CQC, then there is little prospect of an inspection at this time to enable a change in rating. As a result, many providers are frustrated with this and feel “stuck” with an out of date rating.
As expected, a sharp focus of the report is the workforce challenge facing the ASC sector. The report recognises that the struggle faced by ASC providers to attract and retain staff is “serious and deteriorating” despite the recently announced Government future investment in health and social care. The report references an emotionally depleted workforce that has given its all over the past 18 months, whilst also seeing the responsibilities of a carer role increase during this time. This has happened through carers assuming the role of family and loved ones, who could not visit relatives during lockdown, and carers undertaking tasks normally performed by health professionals.
CQC’s own data shows that vacancy rates in residential care homes sat at 6% in April 2021 but rose to 10.2% in September 2021. Sadly, some care homes are cancelling their registration to provide nursing care because of the recruitment problems. CQC’s expectation is that vacancies will increase further with the hospital and travel sectors opening up, which are likely to offer higher salaries; the impact of the mandatory vaccination law taking effect in care homes on 11 November 2021 will be a further contributor to the crisis. CQC suggests that this exodus will continue unless a new deal for the care workforce is developed. Such a deal must consider recruitment and retention, training, pay and rewards, the professionalisation of the workforce and workforce resilience.
Impact of the Pandemic – Other Key Issues
According to CQC’s Market Oversight scheme data, non-specialist care homes (mainly those that care for older people) felt the impact of the Pandemic most. This group saw a fall in occupancy throughout 2020/21. Added to this was the high cost of PPE requirements, additional staffing and fluctuations in Government support and many ASC providers have seen their profitability fall. As a result ASC providers have less money to pay debts and to invest in making quality improvements, or to expand, an existing business. On the other hand, homecare providers have seen stable or improved profit margins over 2020/2021. Interestingly, CQC’s data is also indicating that the Pandemic has resulted in a change in the funding mix within care homes. In particular, non-specialist care homes are seeing a decrease in the proportion of privately funded beds relative to those funded by the local authorities or NHS.
Learning from the Pandemic must continue according to CQC. Many good initiatives commenced during this time, which have brought about improvement or perhaps some longer-term solutions to the ASC sector. For example, the “discharge to assess fund” (which guaranteed four weeks of centrally paid-for care support for people ready to be discharged from hospital) not only improved hospital discharge but was also a business lifeline for some ASC providers. According to the regulator, longer term funding in this way would help providers make longer-term investment for their business to enable much needed step-down care.
The report also recognises the need for better and consolidated data “to remove duplication and improve how adult social care data is collected in the sector”. CQC has already indicated that this is something it will be focusing on in its 5-year strategy. Further, there is a need for better integration of ASC providers into system-wide level planning and decision making. Smaller providers and home care workers, as well as services for people with learning disabilities, felt excluded from such planning.
The above is a snapshot of some of the issues and challenges acknowledged by CQC in the report. It is of course helpful that the regulator continues to use its voice in a public report to highlight the real and current challenges faced by the ASC sector, particularly the national workforce issue. No doubt the hope of ASC providers and registered managers is that CQC’s own inspectors won’t forget these challenges when they step over the inspection threshold; but rather will use the information as context to make fair and reasonable judgments on what they see.
The full report can be read here: State of Care | Care Quality Commission.
If you would like to discuss this topic in more detail, please contact Siwan Griffiths, Partner.