The quality of health and social care services has been largely maintained despite funding, demand and workforce pressures, according to the Care Quality Commission. However, the regulator has warned the impact of a long-term funding settlement for the NHS risks being undermined by the lack of a solution for putting social care on a sustainable footing.
The CQC’s State of Health Care and Adult Social Care in England 2017-18 report also said that, while some people are receiving good quality care and support, others are unable to access services they need with provision either disjointed or of poor quality due to a lack of effective collaboration between councils, the NHS and other partners.
The CQC said its reviews of local health and care systems have shown poor collaboration between services was leading to unnecessary emergency admissions to hospital, which continue to rise and reached record levels in July 2018.
The report highlighted the continued fragility of the adult social care market as a key threat to collaboration as a significant number of providers either close down or hand contracts back to councils.
The number of people with unmet needs is also said to be continuing to rise, with a 20% increase over the last two years to one in seven older people.
The report said: “While the government made a welcome NHS funding announcement in June 2018 the impact of this, and last week’s short-term crisis funding for adult social care, risks being undermined by the lack of a long-term funding solution for social care.”
The report said, between April 2016 to July this year, changes in nursing home bed numbers ranged from a 44% rise in one local authority to a 58% reduction in another, with almost a third of adult social care directors saying they had seen home care providers close or cease trading in the previous six months.
The CQC also found substantial variations in the proportion of people accessing services who are funded entirely by councils and those paying for themselves.
The report said data suggests the areas with the lowest reliance on self-funders are in the North East and London, with the South West and South East having the highest.
With current levels of funding, “the areas with the highest reliance on public funding are likely to be considered least financially sustainable by adult social care providers”, the report added.
The CQC said it also found a “weak but statistically significant correlation” between low unemployment and high care home vacancy rates at local authority level.
Leadership and safety, which are two of five key factors during CQC inspections, were highlighted as key concerns as they received the lowest proportion of good or outstanding ratings.
At the end of July this year, 77% of services were rated outstanding or good for leadership, with 21% rated good and 2% inadequate, which shows little change on last year.
“Considering the strong link between good leadership and high-quality care, this is an area that providers need to focus on,” the report added.
Similarly, 79.5% of services were rated good or outstanding for safety compared to 76.5% last year, while 21% were rated good and 2% inadequate.
CQC chief executive Ian Trenholm said the report’s findings demonstrate “both the resilience and the potential vulnerability” of the health and care system.
“This is not so much a postcode lottery as an integration lottery,” he said. “We’ve seen some examples of providers working together to give people joined-up care based on their individual needs. But until this happens everywhere, individual providers will increasingly struggle to cope with demand – with quality suffering as a result.”
Responding to the report, president of the Association of Directors of Adult Social Services Glen Garrod said: “The fact that a postcode lottery of access and quality now exists, with many areas at or beyond a tipping point owing to care funding shortfalls, is both a highly personal and a national tragedy.
“The need for the government to publish its green paper, which must contain a long-term funding solution, is urgent, but in the meantime, the government must seize the opportunity of the budget to provide more resources to support social care for the population, in order to cope with our growing national care crisis.”