CQC publish their latest edition of The State of Health Care and Adult Social Care in England 2017/2018
Yesterday, CQC published The state of health care and adult social care in England 2017/18.
The report is their annual assessment of health and social care in England and looks at the trends, highlights examples of good and outstanding care, and identifies factors that maintain high-quality care.
This year’s State of Care report tells a story of contrasts. Most people in England receive good care, but quality and access to care are not consistent, and people’s overall experiences are varied with access to good care increasingly dependants on how well local systems work together.
Safety remains a concern
In the NHS, 40% of acute hospitals’ core services and 37% of mental health trusts’ core services were rated as requires improvement on safety at the end of July 2018. All providers are facing the same challenges – in acute hospitals, the pressure on emergency departments is especially visible – but while many are responding in a way that maintains quality of care, some are not.
There have been some improvements in safety among GP practices – and to a lesser extent in adult social care, although they do have some concerns about the sustainability of the improvements in this sector.
Adult social care: the “tipping point” has now been reached for some
The adult social care market remains fragile – particularly in home care, with providers continuing to close or cease to trade and with contracts being handed back to local authorities. Two years ago, CQC warned that social care was ‘approaching a tipping point’ – as unmet need continues to rise, this tipping point has already been reached for some people who are not getting the care they need. While the Government made a welcome NHS funding announcement in June 2018, and more recently the Secretary of State has announced further funding to support the sector through winter, the impact of this funding risks being undermined by the lack of a similar long-term funding solution for social care.
People’s experience of accessing services varies depending on where they live, what services they use and how services work together
In this year’s report, we have focused on people’s experience of accessing health and care services alongside their ratings of providers. Two things are clear – that people’s experience of care varies depending on where they live and what services they use; and that these experiences are often determined by how well different parts of local systems work together. Some people can easily access good care, while others cannot access the services they need, experience ‘disjointed’ care, or only have access to providers with poor services.
Some people are experiencing geographic disparities particularly acutely. It cannot be right that people’s care depends on where they live or the type of support they need. But this is not so much a ‘postcode lottery’ as an ‘integration lottery’. In too many cases, ineffective co-ordination of services was leading to fragmented care. Funding, commissioning, regulation and performance management all conspired to encourage a focus on individual organisational performance, rather than ensuring people got joined-up care based on their individual needs.
In some places services are working well together as part of an effective local system
There is cause for optimism. In some areas, people are benefitting from successful local initiatives and providers that are joined-up with a focus on individuals’ care needs: there are examples of integrated care hubs where hundreds of people have avoided a hospital visit.
Addressing the local system challenge will also mean health and social care services pooling resources to use technology to deliver common goals and improve quality of care. In the NHS, for example, electronic immediate discharge summaries have improved patient safety.
Good, personalised, sustainable care in a local area is no longer just about whether individual organisations can deliver good care, but whether they can successfully collaborate with other services as part of an effective local system. The urgent challenge for Parliament, commissioners and providers is to change the way services are funded, the way they work together, and how and where people are cared for. The alternative is a future in which care injustice will increase and some people will be failed by the services that are meant to support them, with their health and quality of life suffering as result.