COVID-19 has 'exacerbated' an 'already fragile' social care system says CQC report

COVID-19 has exposed an ‘already fragile’ social care system which has faced 'significant challenges' due to lack of PPE, staffing and testing, with long-standing need for reform ‘thrown into stark relief by the pandemic’ warns the Care Quality Commission (CQC).

The CQC's annual State of Care report states ‘in social care, COVID-19 has not only exposed but exacerbated existing problems.

'The sector, already fragile, faced significant challenges around access to PPE, testing and staffing – and coordinated support was less readily available than for the NHS.

‘The long-standing need for reform, investment and workforce planning in adult social care has been thrown into stark relief by the pandemic.’

Little has changed in quality of social care

The report reveals that little has changed in quality of social care, with 80 per cent of adult social care services rated as good which is the same as last year and five per cent rated outstanding, slightly up on last year which saw four per cent rated outstanding.

However the CQC notes that the progress of change in the way care has been delivered during the pandemic has been 'extraordinary'.

Ian Trenholm, chief executive of CQC, said: “Pre-COVID, the health and care system was often characterised as resistant to change. COVID has demonstrated that this is not the case. The challenge now is to maintain the momentum of transformation, but to do so in a sustainable way that delivers for everyone – driven by local leadership with a shared vision and supported by integrated funding for health and care.”

Mr Trenholm recognises there is an opportunity for government, Parliament and health and care leaders at both national and local level to lay out a vision for longstanding issues in adult social care around funding and operational support, with a new deal for the care workforce.

“This needs to happen now – not at some point in the future,” says Mr Trenholm. “COVID is magnifying inequalities across the health and care system – a seismic upheaval which has disproportionately affected some more than others and risks turning fault lines into chasms. As we adjust to a COVID age, the focus must be on shaping a fairer health and care system – both for people who use services, and for those who work in them.”

'Social care deserves parity of esteem with the NHS'

Cllr Ian Hudspeth, chairman of the Local Government Association’s Community Wellbeing Board, said: “Social care was already facing severe financial and demand pressures prior to the pandemic, which have since been exacerbated further, as this report highlights.

“Despite this, it should be recognised that service quality still improved slightly prior to the outbreak.

“Social care deserves parity of esteem with the NHS, with the pandemic highlighting the incredibly valuable role of social care in its own right. In particular, action is needed urgently on the care workforce including on pay, professionalisation, skills and training.”

CQC also wants to see a ‘new deal for the care workforce’ with a ‘clear career progression’ which ‘secures the right skills’ and invests in their training along with urgently addressing ‘recognition and value' of all staff.

Veronica Gray, Hourglass (formerly Action on Elder Abuse) deputy chief executive and director of policy said: “Hourglass supports the CQC’s call for a new deal for the care workforce and the recognition of the important role voluntary and community organisations provide. However, we must all work together to take these next important steps.

Ms Gray added: “It must be also noted that there has been no improvement in the ratings for adult social care over the last twelve months, highlighting yet again that much more needs to be done. Likewise, additional long-term funding, and secure investment in adult social care is now long overdue. There needs to be a level playing field.

"The report does well to highlight the fragility of the social care sector, which has suffered from chronic under investment and lack of workforce planning for years. These are issues that must be addressed.”

'Disappointing' that 'report is predominantly a narrative of events'

Care England is disappointed the report has not made recommendations with how the COVID-19 pandemic could have been managed optimally and suggests the CQC should reflect upon its own role during the crisis.

Professor Martin Green, chief executive of Care England, said: “Although this year’s State of Care report makes a raft of important recommendations including a new deal for the adult social care workforce, it is disappointing to note that the report is predominantly a narrative of events which spanned the COVID-19 pandemic, as opposed to a critical reflection of what must change. This is underscored by the lack of internal reflection from CQC as to its handling of the crisis."

The assessment states the challenge now will be to keep and develop the best aspects of these new ways of delivering services while making sure that no one is disadvantaged in the process.

The CQC will carry out targeted programmes of work specifically focused on building resilience across the health and care system as it continues to respond to COVID-19, and look for opportunities to actively support providers who are trying new ways to improve people’s care.

'People with dementia hardest hit by the virus'

Fiona Carragher, director of research and influencing at Alzheimer's Society said: "It's good to see CQC recognising the urgency of fixing social care right now. Coronavirus sent shockwaves through a social care system already teetering on the brink of collapse.

"People with dementia have been hardest hit by the virus and we've been hearing daily via our support line from families desperate to visit loved ones locked away in care homes, and unpaid carers exhausted from lack of help. Many have told us how the people they love are fading away rapidly, we cannot leave the 850,000 people who live with dementia at the mercy of a system not 'fragile' but dreadfully shattered.

"The way ahead is clear [with] an immediate plan for a universal social care system, free at the point of use, that provides quality care for every person with dementia who needs it. Anything less than that is abandoning people with dementia to their fate."

The CQC report also revealed that 67 per cent of NHS acute core services were rated as good and eight per cent as outstanding. Last year 65 per cent were good and seven per cent were outstanding.

In mental health services, inspectors continued to find poor care in inpatient wards for people with a learning disability and/or autistic people. The overall proportion of services rated as inadequate rose from four per cent to 13 per cent – almost entirely based on deterioration in independent services, rather than NHS services.

Eighty-nine per cent of GP practices were rated as good and five per cent as outstanding. Last year 90 per cent were rated good and five per cent outstanding.

To read the full report click here