Our response to the CQC's State of Care report
26 April 2019
The Care Quality Commission (CQC) has issued its State of Care report, their annual assessment of health and social care in England.
In response, Alex Kennedy, head of campaigns and public affairs at Rethink Mental Illness, said:
“This report reflects what we hear on a daily basis through our services and beneficiaries – that the care you get is often a matter of luck. We are particularly concerned about the amount of mental health providers which are rated poorly for safety, and persistent problems in the quality of acute mental health wards. These are issues which disproportionately affect people severely affected by mental illness. The government should commit to using both the NHS long-term plan and the Independent Review of the Mental Health Act to address fundamental issues with the safety and quality of services that people severely affected by mental illness rely on.”
What the report said
The Care Quality Commission’s (CQC) annual assessment of the quality of health and social care in England shows that overall, quality has been largely maintained, and in some cases improved, from last year. This is despite continuing challenges around demand and funding, coupled with significant workforce pressures as all sectors struggle to recruit and retain staff.
However, it is clear that people’s experience of care varies depending on where they live; 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.
CQC’s reviews of local health and care systems found that ineffective collaboration between local health and care services can result in people not being able to access the care and support services in the community that would avoid unnecessary admissions to hospital, which in turn leads to increased demand for acute services.
The most visible impact of this is the pressure on emergency departments as demand continues to rise, with July 2018 seeing the highest number of attendances on record. Emergency departments are the core hospital service most likely to be rated requires improvement (41%) or inadequate (7%). A struggling local hospital can be symptomatic of a struggling local health care system. This indicates that – although good and outstanding primary care is more evenly distributed – there are parts of the country where people are less likely to get good care.
And there is a less immediately visible impact when health and care services do not work well together – on people, like those who use mental health services, who may already have more difficulty accessing support or to have to travel unreasonable distances to get it. For example, inappropriate out of area mental health placements – with some people being placed hundreds of miles from their homes – vary considerably by region. And CQC’s review of children and young people’s mental health services found that some children and young people were ‘at crisis point’ before they got the specialist care and support they needed, with average waiting times varying significantly according to local processes, systems and targets.
Posing a threat to effective collaboration between health and social care is the continued fragility of the adult social care market, with providers closing or ceasing to trade and contracts being handed back to local authorities. Unmet need continues to rise, with Age UK estimating that 1.4 million older people do not have access to the care and support they need. In two years, the number of older people living with an unmet care need has risen by almost 20%, to nearly one in seven older people. 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.