CQC State of Care report shows 'quality of care placed in jeopardy by underfunding'

The Care Quality Commission's (CQC) State of Care Report on the quality of health and adult social care in England, has revealed that more than 60 per cent of adult social care services have been rated either ‘Good’ or ‘Outstanding’.

Yet the CQC has revealed that there still remains an unacceptable level of poor care in England, with 40 per cent of care providers rated as ‘Inadequate’ or ‘Requires Improvement’.

This signals the significant variation in quality and safety that continues to be the biggest concern across the sectors that the CQC regulates.

Leaders in the care sector have attributed the variation in quality and safety to lack of funding, with Martin Green, chief executive of Care England, saying the "quality of care" is being "placed in jeopardy by underfunding".

Commenting on the findings, chief executive of the Care Quality Commission, David Behan, said: "The health and social care sector is facing an unprecedented level of challenge – so it’s encouraging that our findings show that the majority of people are receiving good or outstanding care.

"However, we have also found a wide variation in the quality of care people receive. Alongside good care we have seen examples of poor and unacceptable care. A key concern has been safety – a failure to learn when things go wrong, or not having the right number of staff in place with the right skills.”

Care England, the largest representative body for independent social care providers, has responded to the report. The organisation maintain that although the care sector is improving in quality of care services, and despite vastly different levels of funding, it compares favourably to the NHS.

The State of Care Report revealed that 85 per cent of GP practices were rated as Good or Outstanding, yet 57 per cent of hospitals Required Improvement.

Improve quality

Professor Martin Green, chief executive of Care England, said: “The key message of the CQC report for social care, is that all the strides that have been made in successive years to improve quality are now being placed in jeopardy by underfunding.

“The sector is increasingly fragile and on the cusp of viability, and if the Government does not heed to the warnings of the independent regulator there will be a crisis in care and hundreds of thousands of people will be denied services and aspirations of the Care Act 2015 that simply will not be delivered.”

The CQC report highlights that leadership – at all levels – is key to running a successful organisation, and turning around a failing one, with the ability to recognise a problem, coupled with the ability to change.

The inspectors identified strong leadership as a crucial factor among the care providers rated as either Good or Outstanding.

Mr Behan added: “The variation in care that we have observed is not just about the money. Good leaders are what make the difference – leaders who engage staff and people who use services and create a culture of continuous quality improvement. What is very clear is that isolated working and incremental changes are not going to be enough to meet the challenges ahead.”

The report indicates that there still remains an inadequate level of care within the sector, as providers are under pressure due to demand and increasing costs.

Safety

The State of Care report has highlighted that safety continues to be the leading problem for which care providers are rated as Inadequate and Requires Improvement. It states: ‘Safety continues to be the biggest concern across all of the services we inspect. Our analysis highlights a range of factors affecting safety across all of the sectors. These include: a failure to adequately investigate and learn from incidents and errors so they don’t happen again, concerns around the adequacy of staffing numbers and staffing mix, failure to undertake safety checks and staff not being able to raise concerns.’

Davina Ludlow, director of carehome.co.uk, a leading online guide to care homes, commented: “As the CQC’s report highlights, the vast majority of care homes provide fantastic support, in warm and friendly communities - to some of the most vulnerable people - every single day.

“However, it is unacceptable that seven per cent of care in England is inadequate, and we welcome the CQC’s robust approach in taking enforcement action on providers who fail to improve.

“It has been a year since the CQC introduced its new inspection regime of rating care providers - we believe it has helped simplify the process of looking for a care home, by making it more transparent and open.

“Everyone involved in the care sector needs to pull together to restore confidence, attract the best people to the profession and promote the excellent work they do.”

Commenting on the CQC’s role in supporting quality care services, Mr Behan continued: “Where people are not receiving the quality of care they deserve, we will demand action – and we are now able to demonstrate that half of services have improved following re-inspection. Some services may need further support to improve, and we will continue to work with partners to ensure this happens.

“CQC’s role is to support innovation, share information that can help leaders to better understand the quality of care that their organisation provides. It is also to highlight poor care and poor leadership where we find it, to demand improvement and to take action to ensure that people receive safe, high quality care.”

Social care

Furthermore, a coalition of more than 80 of the country’s leading charities has warned that the results of the State of Care Report is further evidence of a crisis in social care.

Chair of the Care and Support Alliance (CSA), Vicky McDermott, stated: “Over 40 per cent of providers are delivering a poor standard of care and support, which is impacting on the lives of hundreds and thousands of older and disabled people.

“We need the Government to make a significant investment in social care at the Spending Review next month. The Chancellor should use that opportunity to address the chronic underfunding in care. Doing nothing is simply not an option if this country is to honour its obligations to older and disabled people and their carers.”

The CSA suggest that it has become an inevitable result of year on year cuts in social care, which has led to chronic underfunding in the area. Councils have been forced to reduce what they pay to care providers and this has a direct impact on services.

Councils in England report that around £4.6bn has been taken out of the social care system since 2010.

The CSA are clear that without additional funding social care will get worse, further providers will exit the market and people may find there that quality care is no longer available.

Similarly, Voluntary Organisations Disability Group’s (VODG) chief executive, Professor Rhidian Hughes, suggested: “CQC’s informed analysis and commentary on the state of care is a welcome contribution. Attaining the highest quality health and social care is the prize for us all.

“The state of care lays down clear warnings on the fragility of the social care market. Here we face a perfect storm. Demand for support is rising as welfare reforms leave fewer people eligible for help and community-based services are being cut across the country – all as a result of austerity. The chasm is widening between the costs of delivering high quality services and what commissioners pay.

“The Care Act, which came into force in April, and the NHS Five Year Forward View both champion the prevention agenda and integration of health and social care. Yet insufficient funding for high quality frontline services undermines such aims.”

The initial results from the re-inspections for providers rated Inadequate or Requires Improvement have so far suggested that half of providers have been able to improve their ratings within six months.

In a recent annual cross-sector provider survey, the CQC found that almost three-quarters of care providers said that the inspection had helped to identify areas of improvement and over seven out of ten providers said the inspection reports were useful.

The ratings based in the CQC report were published until the 31 May 2015.