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CQC warns fragile adult social care at a ‘tipping point’

The social care sector is increasingly unsustainable, putting further pressure on the health service, the CQC has said in its annual State of Care report.

According to the report, the number of older people receiving local authority funded social care fell by 26% between 2009 and 2014, and 81% of local authorities have reduced their real-term spending on social care for older people over the last five years.

The CQC quoted Age UK figures showing that over a million people who have difficulties with the basic activities of daily living now receive no help at all.

David Behan, chief executive of the CQC, said: “We are becoming concerned about the fragility of the adult social care market, with evidence suggesting that it might be approaching a ‘tipping point’. The combination of a growing, ageing population, more people with long-term conditions and a challenging financial climate means increased need but reduced access.

“The result is that some people are not getting the help they need – which in turn creates problems in other parts of the health and care system, such as overstretched A&E departments or delays in people leaving hospital.”

The CQC report noted that this year’s Association of Directors of Adult Social Services (ADASS) survey says that 94 councils exceeded their adult social care budgets in 2015-16 by a total of £168m.

Between November 2015 and May 2016, 32 councils had residential and nursing home contracts handed back and 59 had home care contracts handed back, and the CQC warned that more contracts are likely to be cancelled in the future.

Concern about service failures to improve after inspection

As of May 2016, 23% of hospital core services, 10% of GP services and 26% of adult social care services inspected by the CQC were rated ‘requires improvement’, while 5% of hospital services, 3% of GP services and 2% of adult social care services were ‘inadequate’.

The CQC said it was an area of concern that 24% of health and social providers judged ‘inadequate’ and 47% judged ‘requires improvement’ did not improve their ratings following inspection, while 8% of ‘requires improvement’ providers were downgraded to ‘inadequate’.

It said that NHS trusts are facing increasing financial difficulties and performance problems, while GP practices are also struggling to cope with growing pressure.

Peter Wyman, chair of the CQC, said: “We know that tough financial conditions are having an impact on providers. But the focus on the financial problems of the NHS has to some extent masked other issues – reduced access to adult social care and vacancies in primary medical services have led to increased demand in secondary care, which is often not in the best interests of people while generally being considerably more costly.

“Our evidence suggests that finance and quality are not necessarily opposing demands; many providers are continuing to deliver good quality care within the resources available by beginning to transform the way they work through collaboration with other services and sectors.  Leaders now need to think outside traditional organisational boundaries – no amount of money will be able to support the system if this doesn’t happen.”

The CQC said the Five Year Forward View vanguard sites should develop new models of working to address the pressures on the sector. It added that although registrations for the new models were “relatively low”, it expected that to change.

Chris Ham, chief executive of the King’s Fund, said: “The fact that the CQC now believes the social care market is approaching a tipping point adds to the overwhelming evidence that the market is unsustainable in its current form.

“It is essential that health and social care organisations work together in a more co-ordinated way. The new models of care and place-based approaches to planning care now being developed across the country are key to this.”

In addition, the CQC said that the NHS-led sustainability and transformation plans (STPs), were “an important opportunity to determine the right balance between health and social care funding” that would involve “making hard choices about the right balance of investment”.

It added: “All local health and care leaders need to be having a conversation with their local populations about these choices and what they mean – conversations that need to happen now and that need to happen quickly.”

Speaking to the Health Select Committee this week, Chris Hopson, chief executive of NHS Providers, said that the STPs are “over-ambitious” in their current form. The STP process has also been criticised by campaigners for a lack of public involvement.

Saffron Cordery, director of policy for NHS Providers, said: “It is clear that something has now got to give and the State of Care compounds our fears that cuts to social care in particular are pushing the NHS to a tipping point – not only in hospitals but across mental health and community services too.

“With an ageing population that has more complex needs, there is a greater imperative than ever before for responsive and well-resourced social care. The solution is not about ‘health versus social care’, but more about the need for transformative system-wide solutions with realistic funding to accompany them.”

Warning over ‘unrealistic’ public spending

Stephen Dalton, chief executive of NHS Confederation, added that the report shows the NHS is being stretched to the limit, especially after additional pressure caused by ongoing cuts to social care, mental health and public health.

“Public spending plans are becoming less realistic by the day and it’s crucial that the upcoming Autumn Spending Review addresses this crisis,” he said. “Relying on a political rhetoric that promises to protect the NHS, but fails to acknowledge that a cut in social care results in a cost to the NHS, is an economic deception.”

But a Department of Health spokesperson said: “This report from our independent inspectorate shows that the majority of the NHS, 72% of adult social care services and 87% of GP practices inspected are good or better — and that improvement is taking place all over the country.

“The NHS is performing well at a time of increasing demand — the government is investing £10bn to fund its own plan for the future, and crucially is ensuring that the amount of money available to local authorities for social care is rising in future years of the Parliament, reaching up to £3.5bn extra by 2020.”

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