The Care Quality Commission’s (CQC’s) annual assessment of the state of health and adult social care in England, which looks at the quality of care over the past year, highlights that a combination of the cost-of-living crisis and workforce pressures risks ‘unfair care’ for many people.
The report's findings suggest that while record numbers of people are waiting for planned care and treatment, with over 7 million people on elective care waiting lists in June 2023, the true number of people could be much higher, as some people who need treatment are struggling to get a referral from their GP.
In the community, people are facing ongoing struggles with getting GP and dental appointments. As a result, some people are using urgent and emergency care services as the first point of contact, or not seeking help until their condition has worsened.
Once at hospital, people are facing longer delays in getting the care they need. In 2022, over half (51%) of respondents to the CQC's urgent and emergency care survey said they waited more than an hour before being examined by a nurse or doctor, up from 28% in 2020.
Insufficient capacity in adult social care is continuing to contribute to delays in discharging people from hospital. Ongoing staffing and financial pressures in residential and community services are having an impact on the quality of people’s care, with some at greater risk of not receiving the care they need.
The report found ten per cent of maternity services are rated as inadequate overall, while 39% are rated as requires improvement. Safety and leadership remain particular areas of concern, with 15% of services rated as inadequate for their safety and 12% rated as inadequate for being well-led.
Ian Trenholm, CQC’s Chief Executive, said:
“The combination of the cost-of-living crisis and workforce challenges risks leading to unfair care, with those who can afford to pay for treatment doing so, and those who can’t facing longer waits and reduced access. And the impact of unresolved industrial action on people can’t be ignored – it’s crucial that both parties work towards an agreement so strikes do not continue into the winter, when disruption will have to be managed alongside increased demand for urgent care and staff sickness.
“Of course, workforce challenges for the health and social care sector long pre-date the current industrial action. The publication of the NHS Long Term Workforce plan has been a positive step but implementation will be challenging – particularly without a social care workforce strategy to sit alongside it. We continue to call for a national workforce strategy that raises the status of the adult social care workforce and ensures that career progression, pay and rewards attract and retain the right professional staff in the right numbers. It is encouraging that Skills for Care has made this an area of focus.
“We remain concerned that some people are more likely to have a poorer experience of care. To better understand barriers to equality, we’ve commissioned research with midwives from ethnic minority groups, and with people from ethnic minority groups with long-term conditions. We’ve also worked with our expert advisory group for autistic people and people with a learning disability to develop a clearer and stronger position on the use of restrictive practice – we expect all providers to recognise restrictive practice and to actively work to reduce its use."
Responding to the report, Matthew Taylor, chief executive of the NHS Confederation said:
“This sobering report lays bare the critical state that the NHS is in and should provide a salutary warning to political leaders about the abundance of issues facing the health service and the scale of the recovery task ahead.
“After a decade of under-investment in staff, buildings and infrastructure, it is no surprise that we are in this position. We now need a credible plan that helps NHS leaders recover services and rebuild public confidence in what has always been one of the UK’s most valued institutions.
“The report is rightly at pains to point out that there is good work happening across all of the sectors in very tough conditions, particularly around mitigating the risks of staffing shortages, but health leaders will all too readily recognise the many intractable problems outlined within it.
“This should make for deeply uncomfortable reading for the government, with crises on multiple fronts meaning much more help is needed if the gridlocked care system is to have any hope of getting back to where it was in terms of performance a decade ago.
Care England chief executive Martin Green said:
"Despite 70,000 new international workers in the care sector, resulting in a net reduction of 13,000 vacancies, we have lost 57,000 domestic workers. This is not sustainable. Without central government intervention, we may not be looking at gridlock next year, but a total impasse.”
