Following the release of the CQC state of care report which reveals that the social care system is reaching its “tipping point” as a lack of nursing home beds means A&E departments are left buckling under ever increasing demands, industry organisations have been quick to comment:
Serious threats to the quality, safety and stability of England’s social care services are highlighted in the Care Quality Commission’s “State of Care” report, adding to the body of evidence that state-funded care is already at risk from public spending cuts.
United Kingdom Homecare Association (UKHCA), which represents the views of domiciliary care providers, believes that the scale of market exits reported by CQC is concrete proof of repeated warnings to Government by industry insiders.
Independent and voluntary sector providers are beginning to reject contracts with councils where the fees paid cannot support increasing wage bills and enable providers to deliver the quality of care that older and disabled people should be able to expect.
Providers being forced out of care means, that older and disabled people can be left without the home-based support they need to remain independent, and contributes to the increasing number of people left in hospital, despite being medically fit to return home.
UKHCA’s Chair, Mike Padgham, said:
“Government must now take notice of its own statutory regulator’s warning on the increasing instability of the social care market.
“Westminster has largely handed responsibility for adult social care to councils, without giving them sufficient tax-raising powers through the ‘Social Care Precept’ to cover the spending gap.
“The Care Act 2014 has enshrined appropriate responsibilities within England’s social care system, but there is little evidence of active stewardship from Government on how councils meet those responsibilities on the ground. CQC’s report highlights the risks for people who should be able to depend on good state-funded care.”
Chris Ham, Chief Executive of The King’s Fund, said: “It has been clear for some time that cuts in budgets and rising demand for services have left the adult social care system struggling to meet the needs of those who depend on it. This is placing an unacceptable burden on unpaid carers and is leading to rising numbers of people who have difficulty with the basic activities of daily living without any support at all.
“The fact that the CQC now believes the social care market is approaching a tipping point adds to the overwhelming evidence that the market is unsustainable in its current form.
“This is exacerbating pressures on the NHS, as evidenced by the record number of patients who are fit to be discharged but are delayed in hospital. The Government must address the under-funding of social care in the forthcoming Autumn Statement.
“The NHS organisations that are providing high quality care should be congratulated, but it is clear that the severe operational and financial pressures are beginning to take a toll. While this is most visible in acute services, it is also important to highlight the huge pressure on district nursing services, where unmanageable caseloads and shortages of staff risk compromising quality of care, and mental health services, where shortages of beds are making it increasingly difficult to treat patients in crisis.
“It is essential that health and social care organisations work together in a more coordinated way. The new models of care and place-based approaches to planning care now being developed across the country are key to this.
“We also need to recognise that while regulation and inspection are important, on their own they are not enough to ensure high quality care. It is also vital to champion the role of good leadership, a culture of engaging with staff and involving local people in improving services.”
Head of VODG (Voluntary Organisations Disability Group) Professor Rhidian Hughes said:
“Great social care enables people to live the life they choose. But providers cannot deliver high quality care at any cost. Unless we balance disabled people’s needs with sufficient funding we jeopardise day-to-day support and quality of life for 11.9m people in this country. It is imperative that Government uses the Autumn Statement to put things right for social care.”
NCPC welcomes CQC report, but is concerned about future pressures on health and social care
The National Council for Palliative Care is concerned about the variations in end of life care highlighted by the Care Quality Commission in its latest report, The State of Health Care and Adult Social Care In England. The report found that while 59% of acute hospital end of life care is rated Good or Outstanding by the CQC, 41% was rated as Inadequate or Requires Improvement.
Moreover, the CQC identified variations in end of life care, with some groups experiencing poorer quality care. One source of variation was a failure in some places to have early end of life care conversations with dying people, leading to lack of understanding of individuals’ needs.
Simon Chapman, Director of Policy and External Affairs for the NCPC said “Everybody has a right to good quality end of life care, whoever they are, wherever they live and whatever their circumstances. This report from the CQC shows that many places are managing to deliver this, but too many are not. Poor quality end of life care means greater and unnecessary suffering for individuals and their families. That’s why the Government has recently made a National Commitment to improve end of life care. Local decision-makers in health and care need to review what people’s experience of end of life care is like in their area and make plans to improve it.”
The NCPC also flagged concerns about the future of care. Says Simon “the CQC report points out that overall the health and social care system is delivering good care to most people in tough financial conditions. But we know from demographic data that the number of people dying in England each year will rise from about 480,000 in 2015 to about 550,000 by 2035, and increasingly people are dying over a longer period of time of complex conditions. Good end of life care is about maintaining a good quality of life for as long as possible, and we fear that a system that is already under pressure may struggle to cope as the numbers needing end of life care increase.”
Simon also said “what this report also shows is the need for good conversations about end of life care choices. Health and care staff need to be trained to have these conversations, but we all owe it to ourselves and our families to start thinking about our own choices. The Government’s National Commitment on End of Life Care gives a most welcome emphasis on individual choice, but how many of us even know what the full range of options are?”