CQC Report Highlights 'Care Injustice'

Nicky Broyd

October 11, 2018

The Care Quality Commission (CQC) has issued its annual State of Care report for 2017-18 in England, highlighting what it calls 'care injustice' for some, 'disjointed care' for others, 'ineffective collaboration', and an 'increasingly stretched' workforce.

Overall, it found most people do receive a good quality of care, but there's "a story of contrasts", saying: "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'."

The report states: "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."

Last month, a King's Fund and Alliance Manchester Business School report found there was room for improvement in the CQC's own inspection processes.

Report Process

The CQC compiled its report based on five factors affecting "the sustainability of good care for people":

  • Access to care and support

  • Quality of care for people

  • Workforce to deliver care

  • Capacity to meet demand

  • Funding and commissioning

Report Findings

  • Access: Access to care varied across the country with some people unable to access the services they need, or their access is to providers offering poor services. The GP workforce is increasingly stretched with patient satisfaction with appointment times ranging from 45% to 79%. Patients waiting 18 weeks for hospital treatment after referral rose by 55% from 2011 to 2018, with some people travelling long distances for inpatient treatment.

  • Quality:  Improvements to key services were noted with 'good' ratings for 91% of GP practices, 79% of adult social care services, 60% of NHS hospital core services, and 70% of NHS mental health core services. However, the report noted: "The safety of people who use health and social care services remains our biggest concern."

  • Workforce: Problems were identified in recruiting and retaining newly qualified GPs in some parts of England. Vacancies were also an issue in adult social care and children's and young people's mental health services.

  • Capacity: There were more attendances at emergency departments than ever, and the number of care home beds dropped slightly. Nursing home bed numbers rose in some areas but fell in others. The report noted that: "Demand is rising inexorably, not only from an ageing population but from the increasing number of people living with complex, chronic or multiple conditions." The need for coordination was highlighted: "Services need to plan – together – to meet the predicted needs of their local populations, as well as planning for extremes of demand, such as sickness during winter and the impact this has on the system." 

  • Funding: The report acknowledges recent government health and social care funding announcements but, "at the time of writing, there is no similar long-term funding solution for adult social care. A sustainable financial plan for adult social care will be an important element of both the forthcoming social care Green Paper and the wider Spending Review."  


Responding to the report, a Department of Health and Social Care spokesperson said: "It is testament to our hardworking, dedicated NHS and social care staff that the vast majority of patients continue to receive good, safe care and many parts of the NHS have improved since this time last year.

"We want the NHS to be the safest healthcare system in the world – and this starts by ensuring every single patient in this country receives the highest quality of care, no matter where they live. This is backed by our long-term plan to guarantee the future of the NHS with an extra £20.5 billion a year by 2023/24.

"We are addressing immediate pressures on the NHS this winter with an extra £420 million to redevelop A&Es, improve emergency care and help get patients home quicker, freeing up hospital beds for those who need them.”

BMA Council Chair Dr Chaand Nagpaul, said it was thanks to the efforts of doctors and other staff "that the NHS has managed to maintain high standards of care overall, despite the ongoing pressures of rising demand, workforce shortages and chronic under-resourcing.

"In particular, it is encouraging to see such a high proportion of GP practices performing so well and improving on last year's figures at a time when the profession faces its own unique struggles."

Turning to A&E departments, he said: "In a year that saw a record number of patients spending longer than 12 hours in A&E and waiting lists for operations hit a decade-long high, these figures are a reflection of the 'inadequate' resources and capacity that hospitals are running on that cannot meet the rocketing demand for services."
Looking ahead to new plans for the NHS in England, he added: "Next month, the government will unveil its long-term plan for the NHS, and this must address the core resource needs of GP practices and hospitals to ensure patients are confident that the care they receive will be safe, of high quality, timely and easily accessible, regardless of where they live in the country."

Richard Murray, King's Fund director of policy, said: "That the overall quality of the care provided has been maintained is testament to [the] effort and resilience of NHS and social care staff. However, today's report lays bare the challenge of years of squeezed funding, compounded by significant workforce shortages and rising demand for services. This is taking a toll on access to health and social care and some people cannot get the services they need. 

"Joined up services are the key to high quality care. The NHS long term plan must include firm action and dedicated funding to change how health and care services are delivered, and the government's long-awaited social care green paper must tackle the legacy of years of underfunding and workforce problems in social care."

Jeremy Hughes, Alzheimer's Society chief executive, said: "In 2016 the CQC warned social care was at a tipping point, and this adds to our evidence that the system has clearly passed that point now, leaving 850,000 people with dementia at the mercy of a potentially unsafe system and putting yet more pressure on the NHS. People with dementia have a right to care, and their postcode should not affect that." 

Speaking for the Patients Association, Head of Policy John Kell said: "Several items of particular concern leap out. The fact that July saw the highest number of A&E attendances on record – in the middle of summer, even if an unusually hot one – gives us anxiety about the winter ahead.

"Worse still, our entire model of social care appears to be in active collapse, with providers exiting the market and handing contracts back – no wonder that the CQC report poor levels of access for people who need social care. It is inexcusable that things have been allowed to get this bad."


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