The Care Quality Commission’s (CQC) annual assessment of the quality of health and social care in England shows that overall, quality has been largely maintained, and in some cases improved, from last year. This is despite continuing challenges around demand and funding, coupled with significant workforce pressures as all sectors struggle to recruit and retain staff. The efforts of staff, leaders and carers to ensure that people continue to receive good, safe care despite these challenges must be recognised and applauded.
However, it is clear that people’s experience of care varies depending on where they live; and that these experiences are often determined by how well different parts of local systems work together. Some people can easily access good care, while others cannot access the services they need, experience ‘disjointed’ care, or only have access to providers with poor services.
CQC’s reviews of local health and care systems found that ineffective collaboration between local health and care services can result in people not being able to access the care and support services in the community that would avoid unnecessary admissions to hospital, which in turn leads to increased demand for acute services.
The most visible impact of this is the pressure on emergency departments as demand continues to rise, with July 2018 seeing the highest number of attendances on record. Emergency departments are the core hospital service most likely to be rated requires improvement (41%) or inadequate (7%). A struggling local hospital can be symptomatic of a struggling local health care system. This indicates that – although good and outstanding primary care is more evenly distributed – there are parts of the country where people are less likely to get good care.
Ian Trenholm, Chief Executive of the Care Quality Commission, said:
“This year’s State of Care highlights both the resilience and the potential vulnerability of a health and care system where most people receive good care, but where access to this care increasingly depends on where in the country you live and how well your local health system works together. This is not so much a ‘postcode lottery’ as an ‘integration lottery’.
“We’ve seen some examples of providers working together to give people joined-up care based on their individual needs. But until this happens everywhere, individual providers will increasingly struggle to cope with demand – with quality suffering as a result.
“There need to be incentives that bring local health and care leaders together, rather than drive them apart. That might mean changes to funding that allow health and social care services to pool resources; for example, to invest in technology that improves quality of care. Like the digital monitoring devices for patients’ clinical observations that have saved thousands of nursing hours, the e-prescribing in oncology that’s helping people directly, and the electronic immediate discharge summaries that have improved patient safety.
“The challenge for Parliament, national and local leaders and providers is to change the way services are funded, the way they work together and how and where people are cared for and supported. The alternative is a future in which care injustice will increase and where some people will be failed by the services that are meant to support them, with their health and quality of life suffering as result.”
McNamara, Director of Policy and Influencing at Independent Age, the older people’s charity, said:
“The stark reality is that the lack of a long-term funding solution for social care is letting older people down, and risks undermining all the progress that has been made so far. It’s completely unacceptable that the care you get is dependent on where you live, and on how closely the health and social care services work together in your area. All older people deserve excellent care, no matter where they live, and that’s why we’re calling for free personal care, which would enable older people to access better quality care earlier, help them stay out of hospital and live independently for longer.”
Jeremy Hughes, Chief Executive at Alzheimer’s Society, commented: “People with dementia are the biggest users of adult social care and yet they experience poorer quality care than everyone else, with more than a fifth of dementia care providers failing CQC inspections – a higher proportion than care providers generally.[i] Families call our Helpline in despair because a loved one with dementia needs support but there is nothing available locally or the only care home they can get into is inadequate.
“In 2016 the CQC warned social care was at a tipping point, and this adds to our evidence that the system has clearly passed that point now, leaving 850,000 people with dementia at the mercy of a potentially unsafe system and putting yet more pressure on the NHS. People with dementia have a right to care, and their postcode should not affect that.”
Cllr Ian Hudspeth, Chairman of the LGA’s Community Wellbeing Board, said:
“This report raises important concerns and highlights the brilliant work across the system to maintain quality of care, something that becomes harder each year as the consequences of pressures build further. It also provides yet more evidence of a system under significant pressure and in desperate need of securing a more long-term and sustainable solution for how, as a country, we pay for social care.
“Councils across the country are working closely with their counterparts in health for the benefit of people requiring services, however with people living longer, increases in costs and decreases in funding, adult social care is at breaking point and its potential for helping people to live the lives they want to lead is at risk.
“Over recent years, councils have protected adult social care relative to other services. But the scale of the overall funding picture for local government as a whole means adult social care services still face a £3.5 billion funding gap by 2025, just to maintain existing standards of care. The likely consequences of this are more and more people being unable to get quality and reliable care and support, which enables them to live more fulfilling lives.
“Action is needed, which is why, following government’s decision to delay its green paper on adult social care, the LGA published its own green paper consultation to drive forward the public debate on what sort of care and support we need to improve people’s wellbeing and independence, the need to focus on prevention work, and, crucially, how we fund these vital services.
“The Government must use the Budget and Spending Review to inject desperately needed funding into adult social care and use the green paper to secure the long-term sustainability of the system.”