Care staff give good care in 'toughest climate' but CQC warns it's 'unsustainable'

Most adult social care services are rated as ‘good’ by the Care Quality Commission (CQC) in its latest annual State of Care report but the watchdog warns this is only because of the hard work of staff operating in extreme conditions, within a system that is ‘straining at the seams’.

As of the 31 July 2017, 78 per cent of adult social care services were rated ‘good’, compared to 71 per cent rated ‘good’ the previous year.

Some 19 per cent of adult social care services were rated 'requires improvement' (compared to 26 per cent in 2016). The CQC found only a small minority of care was found to be failing people, with between one per cent and three per cent of providers rated ‘inadequate’.

The CQC says the high level of care it found is ‘unsustainable’ in the long term and its report states the whole adult social care system needs proper funding, resourcing and urgent modernisation.

Sir David Behan, chief executive of CQC, said: “Many providers have used our inspection reports to improve, and we have seen improvements in safety in particular, although this area remains a big concern and focus for us. However, as people’s health and care needs change and become more complex, a model of care designed for the 20th century is at full stretch and struggling to cope with 21st century problems.”

He added: “The fact that the quality of care has been maintained in the toughest climate that most can remember is testament to the efforts of frontline staff, managers and leaders.”

The report’s main finding is that although ‘good’ ratings were high, and in some cases up on last year, these figures were misleading, as they were being achieved under ‘extreme circumstances’ that were unsustainable for different reasons. The hard work of staff to maintain quality of care was the primary reason these figures were being achieved.

The report stated that “complex new types of demand, access and cost” were due to an increasing number of older people “who are physically frail, many with dementia, with more people with long-term complex conditions”, placing “unprecedented” pressure on the system.

4,000 fewer nursing home beds

The CQC said the number of beds in nursing homes had fallen across England. Nursing home bed numbers have fallen by two per cent in two years, equating to 4000 fewer beds. Domiciliary care contracts are also being handed back to councils because providers say the funding is insufficient to meet people’s needs with estimates showing that 'one in eight older people are not receiving the help they need’.

The CQC also found many services that were originally rated as ‘inadequate’ have used the findings of their CQC’s inspection reports to make changes and improve.

Speaking at the Care Show on 10 October, Debbie Ivanova, the deputy chief inspector of adult social care, told attendees: "The results we have found are an absolute credit to the care industry. We have found much that is encouraging. We recognise this is not an easy time for anyone in health and social care. The future quality of care is precarious".

The CQC has now completed its inspection and ratings programme comprising over 28,000 different services and providers. For the first time, this has provided a baseline assessment of the quality of services across England that has not been possible before, enabling greater transparency and understanding of the adult social care sector.

Recruitment, staff retention and lack of nurses a problem

Recruitment and staff retentions were cited as being huge problems in the current system. Skills for Care estimates that there are currently 90,000 vacancies across the care sector at any one time. Domiciliary care agencies continue to report higher vacancy rates than care homes. The report also mentioned that it thought Brexit would impact these figures further.

Green paper for social care postponed again

Referring to the Government's decision to postpone its long-awaited Green paper for social care for the second time until the summer of 2018, the deputy chief inspector told conference delegates: "The future green paper is needed".

The sector responds

Vic Rayner, executive director of The National Care Forum (NCF), said: “Against a backdrop of the most challenging times the sector has ever faced it is encouraging to see an increase in the number of adult social care services that are rated as ‘good’.

“The increase from 71 per cent to 78 per cent is a credit to the registered managers and staff who work in the sector seeking to provide the best outcomes for people using services. Staff continue to prioritise relationships and person-centred practice.

“However, as the CQC have recognised in their report, the stresses and strains on the system, on people using services and on the staff cannot be sustained.”

Martin Green, chief executive of Care England, was critical of the Government’s stagnating adult social care plans and called for long-term planning and funding for the sector.

He said: “This is the second year in a row that the chief inspector at CQC has had to outline the precarious state of social care to Parliament. Parliament can ill afford to ignore the warnings from CQC; there is an urgent need for a long-term funding settlement that will reach the frontline and support sustainable quality services.

“There is a lot of uncertainty in the sector and by dragging its heels on the social care Green Paper, Government simply cannot abdicate responsibility for those in need of care, especially those funded by local authorities.”

'Sad state of affairs'

Jeremy Hughes, chief executive of Alzheimer’s Society, called the State of Care report “a sad state of affairs when all we have to be thankful for is that performance in the health and care system hasn’t dramatically deteriorated”.

He added: “We are in the midst of a crisis where one in eight older people are not receiving the help they need, the number of beds in nursing homes are decreasing and a lack of funding is seeing home care providers exit the market in droves. It is only down to the dedication and hard work of health and care staff that the whole service hasn’t buckled under the strain.”

National disability charity, Sense, called on the Government not to forget about disabled people of working age when looking for a solution for social care funding.

Kate Fitch, head of public policy at Sense said: “The Government’s upcoming Green paper promises to start the conversation about long-term solutions to social care funding, but if it truly wishes to protect the sector it is crucial that the needs of disabled people are not left out of this debate.”

To read the CQC's report 'State of Healthcare and Adult Social Care 2016/17' visit: www.cqc.org.uk/sites/default/files/20171011_stateofcare1617_report.pdf