This is the 2021/22 edition of State of Care
In 2022, the health and care system is gridlocked, unable to operate effectively.
Most people are still receiving good care when they can access it – although this is less likely to be the case for people living in deprived areas, disabled people and people from ethnic minority groups. Too often, however, people just can’t access the care they need. Capacity in adult social care has reduced and unmet need has increased. Only 2 in 5 people are able to leave hospital when they are ready to do so, contributing to record-breaking waits in emergency departments following a decision to admit, and dangerous ambulance handover delays.
What this gridlock means for people is that they are stuck – stuck in hospital because there isn’t the social care support in place for them to leave, stuck in emergency departments waiting for a hospital bed to get the treatment they need, and stuck waiting for ambulances that don’t arrive because those same ambulances are stuck outside hospitals waiting to transfer patients.
As part of a series of coordinated inspections across the urgent and emergency care pathway in 10 integrated care systems, CQC convened a group of 250 health and care leaders - they described the system they work in as one ‘in crisis’¬ and shared their fears that the risk of people coming to harm represents a worrying new status quo.
Health and care staff want to provide good safe care, but are struggling to do so in this gridlocked system. This is reflected in growing dissatisfaction with health and care services both by the public and by staff. More staff than ever before are leaving health and social care and providers are finding it increasingly challenging to recruit, resulting in alarmingly high vacancy rates that have a direct impact on people’s care.
Without action now, staff retention will continue to decline across health and care, increasing pressure across the system and leading to worse outcomes for people. Services will be further stretched, and people will be at greater risk of harm as staff try to deal with the consequences of a lack of access to community services, including adult social care. This will be especially visible in areas of higher economic deprivation, where access to care outside hospitals is most under pressure. In addition to the increased risk of harm to people, more people will be forced out of the labour market – either through ill-health or because they are supporting family members who need care.
Many of the challenges services are now facing are linked to historical underinvestment and lack of sustained recognition and reward for the social care workforce. The crucial role of social care is increasingly being recognised by healthcare leaders – with some taking action to jointly invest in and commission social care services with partners in local government, in recognition of the benefits for their whole local system. While there is no silver bullet, joining up these pockets of local innovation has the potential to help to unblock the gridlock.
Solutions to the problems that affect people’s care can only come from long-term planning and investment, with local areas taking a whole system view that recognises the relationship between health and social care and addresses the root causes behind the immediate and obvious problems. To understand what is driving performance, local leaders need to bring together data and information from providers and other local stakeholders, and agree success measures that are focused on people’s overall experience of care, not limited to organisation or sector.
Better quality data and increased data sharing are critical not only to planning for people’s care needs but to understanding and tackling inequalities in people’s experience of and access to care. From our work across local areas, we know that the current recording of demographic data, especially on ethnicity and disability, is not good enough.
Workforce shortages across all sectors need to be addressed through innovative initiatives that look to the future and can be delivered at a local level. The focus should be on shaping more flexible workforce models that help local systems meet the needs of people – all people – who are in turn empowered to take a more active role in their own wellbeing.
In adult social care, where workforce shortages are particularly acute, this needs to be treated as a national problem with local solutions. The money announced by the government to help speed up the discharge of patients from hospital this winter when they are medically fit to leave, as well as helping to retain and recruit more care workers, is welcome – but there needs to be more focus on long-term planning and investment. With 165,000 vacancies in adult social care, there needs to be a real step change in thinking about how to attract and retain staff.
We are calling for funding and support for ICSs so they can own and deliver a properly funded workforce plan that recognises the adult social care workforce crisis as a national issue and offers staff better pay, rewards and training linked to career progression – a plan that encourages investment in long-term solutions rather than short-term sticking plasters.
In this year’s report, we also highlight our concerns about specific service areas, in particular maternity services and those that care for people with a learning disability and autistic people – areas where our inspections continue to find issues with culture, leadership and a lack of genuine engagement with people who use services. In response to the national challenges faced by maternity services, we have begun a new maternity inspection programme, which aims to help services improve, both at local and national level. Next year, our ongoing programme of work focusing on services for people with a learning disability and autistic people will be extended to residential mental health settings.
We want to celebrate all the good care that is out there – and there is a great deal, from the GP practice in Manchester carrying out ward rounds in care homes, to the new initiatives introduced by the hospital in Newcastle upon Tyne that have improved people’s access to and experience of cancer treatments, to the ICS in Cornwall using inclusive technology to help give people more control of the services they use.
However, the fact is that it is difficult for health and care staff to deliver good care in a system that is gridlocked. There are no quick fixes – but there are steps to be taken now that will help avoid further deterioration in people’s access to and experience of care. By working together to address the issues that lie behind the gridlock, we can try to make sure that next year, more people can access good, safe health and social care – delivered by a better supported workforce who have more reason to be optimistic about the future.
Ian Dilks OBE