England’s health and care system is ‘gridlocked and unable to operate effectively’, according to the Care Quality Commission’s latest annual assessment, based on CQC inspection activity, information received from the public, and those who deliver care, ‘alongside other evidence’.
While, State of Care 2021/22, says, most people are still receiving good care when they can access it, too often they cannot access the care they need. Not only has adult social care capacity reduced, and unmet need increased, but just 2 in 5 people are able to leave hospital when ready to do so, which the CQC says is contributing to ‘record-breaking waits in emergency departments following a decision to admit, and dangerous ambulance handover delays’.
As part of work that included a series of coordinated inspections across the urgent and emergency care pathway in 10 Integrated Care Systems (ICSs), CQC convened a group of 250 health and care leaders, who described the system they work in as ‘in crisis’, and shared their fears that the risk of people coming to harm ‘represents a worrying new status quo’.
The CQC said: “Health and care staff want to provide good, safe care, but are struggling to do so in a gridlocked system. This is reflected in growing public dissatisfaction with health and care services – mirrored in staff dissatisfaction. More staff than ever before are leaving health and social care, and providers are finding it increasingly challenging to recruit, resulting in alarmingly high vacancy rates, which have a direct impact on people’s care.”
State of Care 2021/22 warns that, ‘without action now’, staff retention will continue to decline across health and care, increasing pressure across the system and leading to worse outcomes for people. Services will be further stretched, and people will be at greater risk of harm, as staff try to deal with the consequences of a lack of access to community services, including adult social care. This – the CQC maintains – will be especially visible in areas of higher economic deprivation, where access to care outside hospitals is most under pressure.
Unsurprisingly, the Commission says, many of the challenges services are now facing are linked to ‘historical underinvestment’, and lack of sustained recognition and reward for the social care workforce. The CQC said: “The crucial role of social care is increasingly being recognised by healthcare leaders – with some taking action to jointly invest in and commission social care services with partners in local government, in recognition of the benefits for their whole local system. While there is no silver bullet, joining up these pockets of local innovation has the potential to help to ease the gridlock and improve outcomes for people.”
Solutions to the problems that affect people’s care ‘can only come from long-term planning and investment, with local areas taking a whole system view that recognises the relationship between health and social care, and addresses the root causes behind the immediate and obvious problems’, the CQC adds. Local leaders need to bring together data and information from providers and other local stakeholders, and agree ‘success measures’ that are focused on people’s overall experience of care, ‘not limited to organisation or sector’.
CQC’s work across local areas has highlighted that the current recording of demographic data, especially on ethnicity and disability, is not good enough. Workforce shortages across all sectors must also be addressed, with a focus on ‘shaping more flexible workforce models that help local systems meet the needs of all people – who are in turn empowered to take a more active role in their own wellbeing’. In adult social care, where workforce shortages are particularly acute, the Commission argues that there needs to be increased funding and support for ICSs, ‘so they can own and deliver a properly-funded workforce plan that recognises the adult social care workforce crisis as a national issue, and ensures that pay and rewards attract and retain staff’.
Specific services areas facing particular problems include maternity services, and those that care for people with a learning disability and autistic people – areas where inspections continue to find issues with culture and leadership, and ‘a lack of genuine engagement with people who use services’. CQC has begun a new maternity inspection programme, which aims to help services improve, while next year its ongoing work focusing on services for people with a learning disability and autistic people will be extended to residential mental health settings.
Chie Executive, Ian Trenholm, (pictured), said: “The health and care system is gridlocked and unable to operate effectively. There is lots of great care out there – from the GP practice in Manchester carrying out ward rounds in care homes, to the new initiatives introduced by a hospital in Newcastle upon Tyne which have improved people’s access to and experience of cancer treatments, and the ICS in Cornwall using inclusive technology to help give people more control of the services they use.
“However, the fact is that it’s hard for health and care staff to deliver good care in a gridlocked system. There are no quick-fixes, but there are steps to be taken now on planning, investment, and workforce, that will help avoid continuing deterioration in people’s access to, and experience of, care.”