Increased Stability in Social Care Key to Mitigating Risk of “Tsunami of Unmet Need”

The Care Quality Commission (CQC) has published today its annual assessment of the state of health and social care in England. The CQC’s annual assessment of the state of health and social care in England examines the quality of care over the past year – the first of these reports to cover a full year of the pandemic.

The report warns that, unless “increased stability” in social care and “real collaboration across health and social care” are achieved, there is a risk of a “tsunami of unmet need”.

Other warnings from the statement include:

• “As we approach winter, the workforce who face the challenges ahead are drained in terms of both resilience and capacity, which has the potential to impact on the quality of care they deliver.”
• “Staffing pressures are being felt across all health and care settings. However, the impact is being seen most acutely in adult social care, where providers are competing for staff with the retail and hospitality industries.”
• “Increased stability in social care is the key to unlocking not only improved access and quality of care for the people who use it, but to easing pressure on the NHS by reducing emergency attendances and enabling people to leave hospital in a timely way.”

The report praises the success of the vaccination programme which it says has given hope that the virus can be contained, however, is the recognition that COVID-19 will continue to cast a long shadow over all aspects of life, especially the health and care system.

The impact of staffing pressures is being seen most acutely in adult social care, where providers are competing for staff with the retail and hospitality industries. Data from information submitted to CQC by providers of residential care shows the vacancy rate rising month-on-month from 6% in April to 10.2% in September. Some care homes whose attempts at recruitment have failed are now having to cancel their registration to provide nursing care, leaving residents looking for new homes in local areas that are already at, or close to, capacity.

The government has made a welcome £5.4 billion investment to help address the challenges faced by social care. If this money is to make a difference, it must be used to enable new ways of working that recognise the interdependency of all health and care settings, not just to prop up existing approaches and to plug demand in acute care. Five hundred million pounds has been committed to support the adult social care workforce, which is urgently needed for improvements on training, career development and terms and conditions in order to attract and retain staff. Work needs to begin now in order to address the immediate problem of rising vacancy rates as well as planning for the future.

Increased stability in social care is the key to unlocking not only improved access and quality of care for the people who use it, but to easing pressure on the NHS by reducing emergency attendances and enabling people to leave hospital in a timely way. There is short-term funding currently in place to help discharge patients who are no longer in need of hospital care but who may still require care services – this has allowed the NHS to treat more patients and has made a crucial difference to the viability of some social care providers.

If this funding were to be committed to for a longer period, care providers could begin to make longer term investments in staffing to provide much-needed step-down care. They could also build more meaningful relationships with primary, secondary and community care services – as well with third sector organisations and with carers, who have too often been the missing piece of the jigsaw. There is also a need for additional funding to be made available now, rather than next year, to areas that will otherwise struggle to meet people’s needs over the coming winter.

As highlighted in last year’s State of Care, COVID-19 has exacerbated inequalities and continues to do so, meaning that people who were less likely to receive good care before and during the pandemic are in many cases the same groups disproportionally impacted by the virus.

People with a learning disability, for example, are significantly more at risk from COVID-19 – but our review of community care for people with a learning disability found that their physical health, including how COVID-19 may present, was not always considered. Inspections of services for people with a learning disability or autistic people continue to find examples of care so poor that action is needed to keep people safe.

Ian Trenholm, Chief Executive of CQC, said:“This year, more people than ever have contacted us with feedback and concerns about care. And as we go into winter, the health and care workforce are exhausted and depleted – which has clear implications for the vital care they deliver.

“While staffing is an issue for all sectors, we’re particularly concerned about adult social care. We’re seeing rising vacancy rates, some providers having to hand back their registrations as they don’t have enough staff to deliver care, and examples of quality suffering due to lack of staff.

“If the new Government funding is to have an impact, it needs to be used to do things differently and to develop genuinely collaborative ways of working across all care settings. And staff need to be supported and rewarded. In order to attract and retain the right people to work in adult social care, there must be a sharp focus on developing a clearly defined career pathway – linked to training, supported by consistent investment, and better terms and conditions and pay.

“We’re also highlighting the need for an extension to the Discharge to Assess funding in order to capitalise on the benefits it has delivered so far – as well as the need for additional targeted funding immediately to help areas that are struggling get through winter.

“Increased stability on funding and a clear workforce plan for social care benefits everyone – but further instability could result in a ripple effect across the wider health and care system which risks becoming a tsunami of unmet need across all sectors, with increasing numbers of people unable to access care.”

Peter Wyman, Chair of CQC, said: “We know that better, more coordinated care for people happens when local services work well as a system designed around local need. There is no silver bullet to the problems health and social care are facing – so it is more important than ever that we make best use of the resources available by local systems working together to make sure people are being cared for in the most appropriate place, reallocating resources as necessary to achieve this.

“When we conducted a series of provider collaboration reviews across England to look at how systems worked to understand their local populations, we saw how good collaboration made a difference in helping people access care, even during the pandemic.

“The challenge now is for every system to learn from these examples of innovation to ensure that their local population receives the care it needs, with leaders focused on delivering a transformation in the way that people access and experience care.

“The future must be focused on outcomes for people – all people – who need care, supported by transformational changes to workforce, funding, commissioning and oversight. Rather than attempting a return to business as usual, we must grasp this opportunity to build something better – a health and care system that works for everyone.”