State of Care: social care

In this fourth posting in our blog series on the Care Quality Commission's State of care report, we look at what the report tells us about social care.

We share five key takeaways:

1. In the Foreword, CQC state that many of the challenges now faced are linked to a lack of sustained recognition and reward for the social care workforce. They note that the crucial role of social care is increasingly being recognised by healthcare leaders with some acting to jointly invest in and commission social care services in recognition of benefits for their whole local system. CQC acknowledge that whilst there is no silver bullet, joining up pockets of local innovation has the potential to help unblock the gridlock to which they refer. They call upon funding and support for ICSs to own and deliver a properly funded workforce plan that recognises the adult social care workforce crisis as a national issue (and that is a plan encouraging investment in long-term solutions rather than short-term sticking plasters).

2. Interestingly, the report cites NHS leaders warning of a social care workforce crisis in their area which they expect to get worse over winter. Care homes are noted to have found it difficult to attract and retain registered nurses who move to jobs with better pay and conditions in the NHS so care homes are stopping providing nursing care.

3. Over a quarter of care homes told CQC they were actively not admitting any new residents due to workforce pressures.

4. Adult social care gets its own specific mentions at:

• Page 21: this cites the NHS Confederation survey from July 2022 – only four out of 10 patients were able to leave hospital when they were ready to.
• Pages 34 -36: statistics and a case study on waiting for social care assessments.
• Page 44 – 51: capacity and stability of care homes. Readers may be particularly interested in the profit margins or 'EBITDARM' data at Figure 8.
• Page 72: concerns expressed at the high numbers of registered managers leaving therefore creating a knowledge gap around Deprivation of Liberty Safeguards with less experienced managers lacking an understanding about the need to apply for DoLS, particularly when previously granted authorisations had expired.

5. Looking at overall ratings for adult social care, whilst 83% were rated as good or outstanding there was a small increase in the number of ratings of requires improvement and inadequate across residential homes, nursing homes and homecare. Problems on inspection were often related to leadership, management and oversight of the service, driven by staffing challenges.

You can read our earlier State of Care blogs on:

Deprivation of Liberty Protection Safeguards

Learning disability and autism

CQC's State of Care: key messages