A ‘turbulent’ year for health and social care says, CQC

The Care Quality Commission has published its latest assessment of health care and social care in England, looking at the quality of care over the past year. In addition to the ongoing problems of ‘gridlock’ highlighted in last year’s State of Care, this report finds that the cost-of-living crisis is biting harder for the public, staff, and providers – and workforce pressures have escalated. The regulator reports that these issues risk creating a “two-tier system”, with people who cannot afford to pay waiting longer for care.

We share some key points for NHS and independent healthcare providers and adult social care providers.

Ratings 

In its annual report, the regulator said it has continued to take a risk-based approach, focusing inspection activity on those core services that nationally are operating with an increased level of risk, and on individual providers where monitoring identifies safety concerns. The ratings data shows a mixed picture of quality, with a notable decline in maternity, mental health, and ambulance services.

• NHS acute services
  • There has been a 2% drop in services rated good or outstanding compared to 2022, with a similar percentage increase in services rated requires improvement or inadequate.
• Independent health acute services
  • CQC data reveals that 93% of providers were either rated good or outstanding, an increase of 3% from last year and there was a 2% reduction of providers rated requires improvement or inadequate from 9% in 2022 to 7% in 2023.
•  Adult social care
  • The overall ratings data for ASC reveals that for 2023 83% of providers were rated outstanding or good  (compared to 84% in 2022), with 17% of providers rated requires improvement or inadequate compared to 16% last year.

Access to care

• Getting access to services remains an ongoing issue for people with protected equality characteristics.
• People are struggling to get the care they need when they need it.
• Over 7 million people are waiting for planned care and treatment as at June 2023.
• Issues with accessing GP and dental appointments continue to impact emergency care services.
• Lack of capacity in ASC is continuing to contribute to delays in discharging people from hospital.

Quality of care

• Issues with staffing and the resulting impact on the safety and quality of care is a theme emerging from all areas CQC inspect.
• Increasing demand and pressures on staff are taking a toll on their mental health and wellbeing and without support, this is affecting the quality of care they deliver.
• The quality of mental health services remains a concern, with recruitment and retention of staff still one of the biggest challenges.
• The safety of maternity services remains an ongoing concern, with ten per cent of maternity services rated as inadequate overall, while 39% per cent rated as requires improvement. Issues around leadership, poor training and culture persist. Other concerns focus on the inequity of maternity services and the fact that women from ethnic minority groups continue to be at higher risk.

Inequalities

Last year’s State of Care report highlighted that health inequalities “pervade and persist” and this year’s report explores more closely the experiences of people from ethnic minority groups using health and care services. Insights were gained from midwives who described a ‘normalised’ culture where staff tolerate discrimination from colleagues, and say that they are less likely to be represented in leadership and managerial roles.

Health and care workforce

• NHS staff report being overworked, exhausted and stressed to the point of becoming ill or leaving their job. Low staffing levels are impacting the delivery of safe care.
• Only a quarter of staff report being satisfied with their level of pay. Dissatisfaction with pay is reported to be linked to industrial action by healthcare staff during 2023.

Adult social care workforce challenges

• Some providers reported struggling to pay their staff a wage in line with inflation.
• Over 50% of providers surveyed in England said they were having challenges recruiting new staff, and 31% said they were having challenges in retaining them.
• Overseas recruitment in the independent ASC sector has “enhanced the diversity and skills of their team and helped resolve staffing issues”, with over 70,000 people arriving to work in the UK.
• Concerns are raised about a growing theme of “unethical” international recruitment practices, with CQC making 37 referrals for concerns regarding modern slavery, labour exploitation and international visas – a fourfold increase from last year.
• The lack of a fully funded social care workforce strategy to sit alongside the NHS Long Term Workforce Plan means workforce challenges in the sector will continue to persist.

Deprivation of Liberty Safeguards

Ongoing concerns with the current DoLS system persist, with the number of applications to deprive a person of their liberty increasing to over 300,000 and with only 10 per cent of standard applications completed within the statutory 21-day timeframe.

Continuing delays to implementing the new Liberty Protection Safeguards mean that these challenges are likely to continue. In April 2023, the government announced that the implementation would be delayed “beyond the life of this Parliament”. For further details read our blog. 

A changed system: ICSs, ICBs

The health and care system is operating under new architecture with ICSs now formalised along with their Integrated Care Boards. One of the key challenges for systems is improving outcomes in population health and healthcare, reducing inequalities in people’s access to care and their experience and outcomes from care.

CQC will be assessing local systems – all 42 ICSs – to enable them to provide independent assurance to the public of the quality of care in their area. Looking ahead to 2024 when CQC will focus their assessments on health and social care across systems, CQC has started new pilot assessments of ICSs in Birmingham and Solihull and in Dorset. The regulator will be collecting evidence as part of their assessments and speaking to staff and people about their experiences supported by on-site interviews.

In addition, CQC will be assessing how well local authorities are meeting their duties under Part 1 of the Care Act 2014 for people accessing care and support based on a set of quality statements taken from the new single assessment framework.

Ultimately, the Secretary of State for Health and Social Care will approve the final approach to assessments, as required under the Health and Social Care Act 2022.

Do get in touch if you'd like to discuss any of the issues raised here.