Regulator warns of a health and care system in ‘gridlock’

The Care Quality Commission's annual State of Care report was published on 21 October 2022. It is the culmination of inspections (as at 31 July 2022), surveys, information shared through Give Feedback on Care and comments on social media and review sites. The inspections included a programme of coordinated inspections of urgent and emergency care services in ten Integrated Cares Systems.

CQC finds a health and care system “unable to operate effectively”– with patient flow challenges seen in acute hospital wards, emergency departments and ambulance waits. Consequently, public satisfaction has plummeted - see chapter 2.

In one respect this won’t tell readers anything they don’t already know but the report still makes for difficult reading as it is an honest assessment of the immense pressures faced by the sector with concerns expressed that this is a sector “in crisis” and fears shared that the risk of people coming to harm represents a worrying new “status quo”.

It acknowledges that at the heart of these problems are staff shortages and difficulties recruiting and retraining across health and care, resulting in ‘alarmingly’ high vacancy rates (and indeed a whole chapter is devoted to workforce issues – see chapter 5). Lack of capacity in primary care and social care are exacerbating the high pressure on urgent and emergency care services.

People are struggling to access care, the commission said, with over 1 in 5 people (22%) waiting for healthcare services like diagnostic tests, mental health services, consultant appointments, an operation, or a therapeutic service such as physiotherapy. Variations across the country persist with people living in the worst performing areas more than twice as likely to wait more than 18 weeks for treatment as people in the best performing areas.

A staggering 500,000 people are reported to be waiting either for an adult social care assessment, for care or a direct payment to begin, or for review of their care. At the same time, the watchdog finds that care home profit margins are at their lowest level since their Market Oversight Scheme began in 2015. Compounding the issues are workforce pressures with 36% of care home providers and 41% of homecare providers reporting that workforce challenges have had a negative impact on the service they deliver. CQC specifically note staff being drawn into industries with higher pay and less stressful conditions.

The regulator continues to focus on higher risk providers and where people were most at risk of receiving poor care. However overall, when people have been able to access the care they need it has been mostly good as the figures indicate.

  • 83% of adult social care services were rated as good or outstanding
  • 96% of GP practices were rated as good or outstanding
  • 75% of NHS acute core services were rated as good or outstanding
  • 77% of all mental health core services  (NHS and independent) were rated as good or outstanding

But there are deep concerns about some specific types of care:

  • maternity services
  • learning disability and autism services
  • mental health services
  • deprivation of liberty safeguards -  with the risk of people being unlawfully deprived of their liberty

Pulling many of these threads together are the newly created ICSs which will bring with it a new role for the CQC to assess and review each ICS from April 2023. CQC rightly identify that ICSs have a key role to play in driving forward improvements alongside secondary and primary care providers, but funding issues and workforce shortages do threaten their success. They devote the whole of chapter 6 to systems – both challenges and opportunities.

This blog is the first in a six part series exploring some of the themes in the CQC’s annual report.

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