The CQC State of Care Report 2020/21: Key Findings
The key findings are:
Quality and access
The quality of care that people received in England was said to be mostly good, with 80% of adult social care services being rated as good and 5% as outstanding as at 31 July 2021. CQC acknowledged that the pandemic has hindered access to high quality care for some people. What may be skewing these statistics is that CQC carried out very few inspections during lockdown. More recently, since August 2021, where CQC has inspected, many ratings have fallen below good. The ratings reflected in the Report may therefore reflect a more historic position. The changes to the way CQC inspects that are currently being implemented may put more services under pressure in relation to their ratings.
Impact of Covid-19
The pandemic presented the health and social care sectors with major new challenges but the Report emphasises that many of the problems were already present.
Inconsistency is a general theme. For example, the “Discharge to Assess” model has worked better in some areas than others. CQC also observed that lessons learned from the pandemic are being used, by some providers, to plan for the future to improve outcomes for people in the local area. The challenge will be to ensure collaboration and planning happens everywhere.
Many people have had to wait longer to receive treatment or undergo needs assessments. The latter has also been a barrier to people accessing funding and to services getting paid. There is a large backlog across services with CQC stating that interim support needs to be provided. Whilst the NHS are tackling delays through the creation of elective bed capacity and reclaiming operating theatres, it is clear that many more creative solutions are needed.
Integration and collaboration
During the past year, provider collaboration reviews undertaken by CQC has highlighted that collaborative working has been sporadic. In some places, the pandemic has facilitated collaboration between the NHS and social care and improved the sharing of resources, which helped produce better outcomes for people. Unfortunately, this was not the case across the board.
CQC found that where there was less collaboration, there were concerns about the effect on care planning for the local population. The lack of integration of adult social care providers into system-level planning and decision-making presents an obstacle to wider recovery plans for both healthcare and social care, especially with a move towards an integrated care system. While this may not be news to providers, it is good to see CQC acknowledge the need for social care to play a more equal role in planning for the health and care system.
Infection prevention and control (IPC)
In care homes, 69% of providers demonstrated assurance in all eight questions during CQC’s IPC inspections. Ongoing monitoring showed improved IPC measures and compliance.
Staff recruitment and retention continues to be a very significant problem.
Staff are exhausted with CQC saying urgent action is needed to tackle the sector’s growing workforce shortages. CQC states that a focus on clear career pathways supported by funding to attract and retain the right people is necessary. We question whether this will be reflected in Government policy and in the Budget.
Adult social care is of particular concern with rising staff vacancy rates. Some residential and nursing providers are unable to fulfil their existing contracts due to lack of staff. Job vacancies in residential care settings increased from 6% in April 2021 to 10.2% in September 2021. This is an increase of 58% in just 6 months. However, job vacancies in domiciliary care settings and available posts for registered nurses were highest at 11.3% and 13.4%, respectively. This has led to some providers cancelling their registrations to provide nursing care.
Deprivation of Liberty Safeguards (DoLS)
DoLS applications are on the rise. Providers have faced the challenge of balancing adherence to Government guidelines (social distancing, for example) against compliance with DoLS conditions. CQC noted concerns about loneliness and wellbeing in light of restrictions on visitors and isolation.
The use of technology has facilitated virtual best interests assessments but this did not allow everyone to participate. CQC say that better DoLS and Mental Capacity Act training is needed to improve staff knowledge and understanding.
Whilst CQC recognise that care providers have borne the brunt of the pandemic, it is disappointing that the regulator has not used its Report as an opportunity to reflect on its own handling of the crisis or to shed more light on its proposed regulatory approach.
Lessons learned from Covid-19 must be implemented in practice. The Government recently announced £5.4 billion investment into the care system. All eyes will no doubt be on the Government’s future plans for the sector.
Whilst short-term funding has made a difference to the viability of some social care providers, long-term funding to target areas struggling with demand is required. A full copy of the Report can be found here.