Adult social care services have improved overall at a time when financial and demographic pressures continue to grow but the future quality of provision is “precarious”, according to the Care Quality Commission.
The regulator’s annual State of Care report, published today, found 78% of adult social care services had been rated good by the end of July this year, compared to 71% 12 months before.
The proportion of services rated as ‘requires improvement’ fell from 26% to 19% during the same period.
A total of 1% of services, which have the capacity to care for up to 16,000 people, were rated ’inadequate’ – down from 2% last year.
But the report warned that health and social care services are under “severe pressure”, placing continued improvement in doubt.
It said the rising numbers of people with multiple and complex needs is increasing pressures across the system, with an estimated one in eight older people (1.2 million) not receiving the social care they need.
The report cites a fall of 4,000 nursing home beds in the 12 months up to March 2017 as a “particular concern”, with significant variation in levels of provision across the country.
The CQC also said the tightening of eligibility criteria for care has led to a reduction in the volume of support services provided by councils.
It added that there is “substantial churn” in domiciliary care provision, with around 500 agencies registering with the CQC per quarter and 400 deregistering.
The report says this “adds to the uncertainty for the sector as a whole” and creates “a lack of continuity of care” that “deeply affects and worries people using the service”.
The CQC acknowledged that concerns over social care funding have continued following the government’s announcement in March of £2bn additional funding for social care.
It highlighted issues such as the cost of implementing the new national living wage, which will account for a third of the £1bn distributed to councils this year, and fines being imposed on councils by NHS trusts and clinical commissioning groups.
The CQC’s report in 2015-16 said adult social care was “approaching a tipping point” when deterioration in quality of services would outpace improvement.
This year’s report said the current situation “remains precarious, with no long-term solution yet in sight”.
It adds: “Overall, care services are continuing to improve their quality of care… but services rated as ‘good’ are beginning to deteriorate in quality as well and this suggests that improvements may be difficult to sustain.”
The CQC highlighted that, while the majority of delayed transfers of care from hospital remain attributable to the NHS, the sharpest increases have been due to adult social care and patients awaiting a home care package in particular.
The regulator has now begun a series of 20 “local system reviews” focused on how people move though the health and social care system.
The report said: “So far, we have seen that the multi-agency response required from commissioners and providers is in its early stages.
“Cross-sector work is essential to deliver transformational change, but we can see that the processes for this are not yet well developed.”
CQC chief executive David Behan said as people’s needs have become more complex “a model of care designed for the 20th century is at full stretch and struggling to cope with 21st century problems”.
He added: “The impact of this on people is particularly evident where sectors come together – or fail to come together, as the complex patchwork of health and social care strains at the seams.
“The future of the social care system is one of the greatest unresolved public policy issues of our time – a long term sustainable solution is urgently required. The anticipated green paper on adult social care will provide the opportunity for parliament, the public and professionals to consider how we can collectively develop an appropriately funded social care system that can meet people’s needs, now and in the future.”