LGC’s commentary on the Care Quality Commission’s State of Care report.
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The Care Quality Commission’s annual State of Care report, published today, was for the first time based on comprehensive ratings for all sectors following the completion of the regulator’s three-year programme of inspections.
The CQC said this meant it had now established a “full picture” of health and social care in England, with data providing a baseline from which to draw conclusions on what influences the quality of services.
With chronic underfunding at a time of growing acute pressures in the adult social care system well documented, it is perhaps surprising that the report contains some positive news from the frontline.
The report reveals that the percentage of social care services rated ‘good’ and ‘outstanding’ has risen while the proportion of services failing to meet required standards has fallen.
As the Association of Directors of Adult Social Services pointed out, this is a “testament to the dedication of care staff working under significant and continuing pressures” and the CQC itself says that “a great deal has been achieved in exceptionally challenging circumstances”.
However, the CQC makes it clear that any shards of light are surrounded by, and under threat of being consumed by, considerable darkness.
With the capacity of the adult social care system continuing to shrink, eligibility criteria tightening and demographic pressures growing, the report warns that the future of services is “precarious” as increasing numbers of vulnerable people are not receiving the care they need and limited resilience in the system is tested.
As evidence of this increasing fragility and a significant caveat to any good news, the CQC warned that while four-fifths of services were meeting required standards, 23% of services that were rated ‘good’ had deteriorated on re-inspection.
The CQC also highlights significant variation in the quality of services across the country, with some areas moving further away from the tipping point warned of in the regulator’s report last year, while others have moved closer to it.
The CQC highlights the importance of collaboration across the “complex patchwork” of health and social care and the need for a long-term solution to funding. But as many councils have worked with health organisations locally in efforts to build in future resilience across the whole care system, they are being hampered by central government’s firm short-term focus on delayed transfers of care.
Last week the health secretary Jeremy Hunt was preparing to write to 30 councils and threaten to nationally direct how the councils use millions of pounds of social care funding next year if they do not improve perceived DTOC performance.
He is also said to be on the verge of threatening a separate but overlapping group of 20-30 councils with withholding funding this financial year which could be used directly by the NHS to buy care capacity instead.
The government, clearly rattled by warnings over the scale of an impending winter crisis in the NHS, appears to be preparing to ramp up its policy of central control and financial threat outlined in the controversial BCF planning guidance and later bolstered by delayed transfers of care targets being imposed on councils.
The CQC report acknowledges local government warnings that a large proportion of the £2bn of extra funding for social care should be spent on stabilising the entire system, preventing cuts to services and covering the national living wage, while the worrying issue of back-pay for sleep in shifts remains unresolved.
Some councils have remained defiant after rejecting NHS England’s “unacheivable” DTOC targets and submitted trajectories to meet the targets over a longer period.
Talking of delays, there have been suggestions that the government’s green paper on the long-term sustainability of adult social care, initially promised in the autumn, might not be published until next year now as distracted ministers are reluctant to revisit a policy area that proved so toxic during the general election.
As the CQC points out a solution to “one of the greatest unresolved public policy issues of our time” is “yet in sight”. Evidence suggests that, for the foreseeable future at least, a lack of government vision means it will continue to remain out of view.