The Care Quality Commission has chosen to highlight in particular the pressures facing social care services in its annual review of performance across the health and social care system.
The adult social care sector is reaching a “tipping point” in the face of an ageing population and funding constraints, which is in danger of causing a deterioration in the quality of care homes and contributing to pressures placed on hospitals, the CQC has warned.
“We are becoming concerned about the fragility of the adult social care market”
In its annual report on health and care providers, the CQC highlighted that a number of care home providers identified as either “inadequate” or “requiring improvement” had failed to improve their ratings – and in some cases got worse – after being re-inspected.
The regulator also pointed to recent analysis of its own data showing that a previous steady rise in the number of nursing home beds in England had come to a halt in the past 16 months. In addition, the CQC said difficulties in recruiting and retaining nursing staff was leading to poor ratings and fewer beds.
In its State of Care report, published today, the CQC raised further concerns that the reduced quality and capacity in care homes was also affecting hospitals by adding to the pressure from emergency department attendances and admissions, and contributing to a rise in delayed discharges.
For its report, the CQC analysed the ratings handed out to all NHS trusts, health and social care providers and GP practices up until 31 July 2016.
“This is a powerful message from the regulator about the need for change”
While the majority of adult social care services were found to be providing good quality care – 71% rated as “good” and 1% as “outstanding” – around a quarter were not, said the CQC.
Around 500 providers required re-inspection because they were initially rated “inadequate” but of these 25% had failed to raise their standards when the CQC visited the second time.
Of the 1,850 services rated as “requires improvement”, half failed to increase their rating following re-inspection – and in 8% of cases (153) the care had got worse and become inadequate.
The CQC said nursing homes remained the “biggest concern” in the adult social care sector, due to 41% of the total 3,649 being rated inadequate or requires improvement.
It noted that such providers performed particularly badly in safety and leadership assessments due to failings in areas like medicines management and staffing.
Meanwhile, in NHS acute trusts 61% were rated as requires improvement overall, because most have a few core services where the quality could be improved, said the CQC.
In addition, the regulator warned it would be come increasingly difficult for NHS trusts to make improvements to services unless they were able to work more closely with adequately funded adult social care providers.
CQC chief executive David Behan said: “We are becoming concerned about the fragility of the adult social care market, with evidence suggesting that it might be approaching a tipping point.
“The combination of a growing, ageing population, more people with long-term conditions and a challenging financial climate means increased need but reduced access,” he said.
“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,” said Mr Behan.
“When the trend is constantly downhill it is clearly time for very serious concern”
He warned that the health and social care system needed to work together more closely or servcies would deteriorate further next year.
Commenting on the findings, Professor Martin Green, chief executive of Care England, said “underfunding” was “damaging” the sector.
“The current funding settlement entirely disregards demographic change, the pressure on the market, and the impact on people receiving care,” he said. “More providers are pulling out of unaffordable caring activities like nursing.
“Care England members are still being asked to care for adults with complex needs for as little as £2.25 per hour. This undoubtedly affects the NHS, where delayed discharge figures will not improve while social care remains starved,” he said.
Professor Green warned that the “fragility of the market cannot be overstated”. “Providers are being put in a perilous position by a lack of political will to meet the funding needs of social care,” he said.
“The government must take heed and action to reverse a trend of gradual but definite erosion of this sector, a lifeline for many vulnerable people,” he added.
Vic Rayner, executive director of the National Care Forum, said: “Local and national decision makers must recognise and strategically fund the role of care in supporting the ability of individuals to live as independent and healthy lives as possible, outside of the acute sector.
“The report raises the spectre of a ‘tipping point’ for adult social care, and highlights the fragility of the sector,” she said. “This is a powerful message from the regulator about the need for change, and one which I hope will resonate with the chancellor as he prepares his autumn statement.”
Ms Rayner highlighted that the CQC was “not alone in demonstrating the challenges” facing the adult care sector, noting Skills for Care data showing a shortfall in staffing and a King’s Fund report reinforcing the impact of reductions of local government funding on service provision.
“We need to take action now to build on the good and outstanding provision inspection has demonstrated, and work together across the health and social care arena to maximise the potential for person centred provision to positively change lives,” she said.
“Today’s report should act as a wake-up call to the government”
Caroline Abrahams, charity director for Age UK, said: “When any regulator says that it is worried that a service may be reaching a tipping point in terms of quality and sustainability – and when the trend is constantly downhill – it is clearly time for very serious concern.
“Next month’s autumn statement is an opportunity for the government to give social care the priority it deserves in terms of public spending,” she said.
Jeremy Hughes, chief executive of Alzheimer’s Society, said: “This is the second warning in less than a month that social care is in dire straits. The CQC highlights a system unable to sustain itself.
“The NHS and social care go hand-in-hand – we cannot fix one if the other remains broken,” he said. “Social care urgently needs a solid financial grounding before this entire house of cards falls.”
Stephen Dalton, chief executive of the NHS Confederation, said: “The report shows that the NHS is being stretched to the limit, especially after additional pressure caused by ongoing cuts to social care, mental health and public health.
“Relying on a political rhetoric that promises to protect the NHS, but fails to acknowledge that a cut in social care results in a cost to the NHS, is an economic deception,” he warned.
“A major concern is the sustainability of social care provision,” he said. “The CQC report exposes that one consequence of cuts to social care is a ‘race to the bottom’ when awarding contracts to care providers.”
Parliamentary and Health Service Ombudsman Julie Mellor added: “Today’s report should act as a wake-up call to the government. We see far too many cases where frail and older people are being discharged from hospital without the right social care in place.”
The State of Care report, published today, provides the most comprehensive view yet of the CQC’s inspection findings from the new regulatory approach that it rolled out two years ago, said the body.
The revised approach involves expert-led inspections, which in most cases then lead to ratings of “outstanding”, “good”, “requires improvement” and “inadequate”.