Fragile adult social care sector 'at tipping point' despite good care says watchdog

The majority of care homes and home care providers are giving ‘good quality care’, the Care Quality Commission (CQC)’s State of Care report reveals but growing demand and financial pressures mean the adult social care market is ‘approaching a tipping point.’

‘Closures and undeliverable contracts'

Care providers are being forced to shut settings and turn down care contracts from local authorities, despite the fact many give good care and three quarters of 'Inadequate’ care providers improved when they were re-inspected.

As of 31 July 2016, 71 per cent of the adult social care services that the care watchdog had inspected were rated Good.

In the regulator’s report, published on 13 October, it states: 'Large numbers of care homes and home care agencies are providing good quality care – and three-quarters of those that we had rated as inadequate, and then re-inspected, improved.'

Financial woes

But the report warns: 'Profit margins are reducing – both due to pressures on fees, and cost pressures that include the national living wage. Already we are seeing some providers starting to hand back home care contracts as undeliverable; local authorities predict more to come.'

The number of older people receiving local authority-funded social care fell 26 per cent from more than 1.1m in 2009 to around 850,000 in 2013/14. Some 81 per cent of local authorities have reduced their real-term spending on social care for older people over the last five years.

The report highlighted the case of Mears Group having served notice to Liverpool City and Wirral councils for offering hourly rates of £13.10 and £12.92 respectively, compared with the minimum of £16.70 recommended by the UK Homecare Association. The CQC stated: ‘They said this would “lead to unworkable pay and conditions for care workers” and “the people who will suffer the most are those receiving care.”

Potential rise in unpaid care

The regulator said that with smaller providers being more susceptible to closures ‘we are concerned that reduced capacity limits people’s choices and ‘may force local authorities to use poorly performing providers.’

The CQC believes the potential impact of care providers exiting the market would be people having less choice, a lack of continuity of service, delays in getting a package of good care and a rise in the use of unpaid care.

Nursing home bed growth stalls

Until recently, the growth in demand for care for people with greater care needs had been met by a rise in the number of nursing home beds, but this bed growth has stalled since April 2015. CQC data shows that a five-year period of steady increase in nursing home beds (up from 205,000 beds in 2009 to 224,000 beds in March 2015) has since remained static.

Care home managers, academics, clinicians and frontline care staff gathered at the Care & Dementia Show in Birmingham on 11-12 October, where the subject of sector underfunding and the mounting pressures on care providers was echoed in the pained conversations people had.

Staffing struggles

While positive innovations are taking place at Good and Outstanding homes, recruitment and retention challenges, highlighted by the CQC's report, were issues felt by two nurses who have collectively spent 35 years working in nursing homes.

Speaking to carehome.co.uk, one nurse attending the event who did not wish to be named, said: “We just can’t get the staff. We’re finding it hard to recruit the nurses we need to come out to our nursing home. It's the same story for the other homes in the group. I don’t know what the solution is”.

David Behan, chief executive of the CQC said: “We are becoming concerned about the fragility of the adult social care market. The combination of a growing, ageing population, more people with long-term conditions and a challenging financial climate means increased need but reduced access. The result is that some people are not getting the help they need - which in turn creates problems in other parts of the health and care system, such as overstretched A&E departments or delays in people leaving hospital."

Delayed discharges

The CQC report, based on inspections, ratings data and feedback from those needing care, also highlighted that in 2015/16 there was an increase in the number of people forced to wait to be discharged from hospital.

The report stated: “The difficulties in adult social care are already affecting hospitals. Bed occupancy rates exceeded 91 per cent in January to March 2016, the highest quarterly rate for at least six years. And in 2015/16, we saw an increase in the number of people having to wait to be discharged from hospital, in part due to a lack of suitable care options.”

Greater collaboration needed

Mr Behan added: “While there are no easy answers or quick fixes, what distinguishes many of the good and outstanding services is the way they work with others – hospitals working with GPs; GPs working with social care and all providers working with people who use services. Unless the health and social care system finds a better way to work together, I have no doubt that next year there will be more people whose needs aren’t meet, less improvement and more deterioration.”

In the report entitled: ‘The state of health care and adult social care in England 2015/16’ the CQC has made a number of recommendations for integrated care for older people.

• It stressed care plans should be streamlined and information shared across services.

• Ensure older people are fully involved in their care.

• Organisational barriers should be broken down to enable services to intervene early when people are at risk of unplanned hospital admissions.

• Data for integrated care should be developed.

Chris Ham, chief executive of The King’s Fund, said: “The fact that the CQC now believes the social care market is approaching a tipping point adds to the overwhelming evidence that the market is unsustainable in its current form.

“While this is most visible in acute services, it is also important to highlight the huge pressure on district nursing services, where unmanageable caseloads and shortages of staff risk compromising quality of care.

“It is essential that health and social care organisations work together in a more coordinated way. The new models of care and place-based approaches to planning care now being developed across the country are key to this."

Martin Green, the chief executive of Care England,added: "I am proud to say that CQC’s State of Care report shows that, at a time of unprecedented financial constraints and rising need for care, 71 per cent of the adult social care services inspected were rated ‘good’.

"Despite the excellent work of social care workers and managers, underfunding is damaging the sector. Care England members are still being asked to care for adults with complex needs for as little as £2.25 per hour."

Caroline Abrahams, charity director for Age UK, was among those calling for more social care funding in the Autumn Statement. She said: "Because of lack of money and the drip drip closure of care providers it is becoming ever harder to find good, affordable care.

“Next month's Autumn Statement is an opportunity for the Government to give social care the priority it deserves in terms of public spending and this report shows how important it is that the Government acts. Otherwise 'a tipping point' threatens to become something infinitely worse, placing many older people at risk of harm.”