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CQC State of Care report: Despite improvements, access, flexibility and quality remain barriers to true reform

Last month, the Care Quality Commission released its annual assessment of the state of the care system in England in 2020/21—the care sector’s own health-check, in other words. The CQC have used data from their inspections, plus testimony from service users, families and carers. Here we look at what they found, why these findings are important and useful for GP surgeries, and whether they can really drive change and improvement.

Why is this report important?

Although it focuses on the care sector and care homes, it also looks at other parts of primary care such as GP surgeries, dentists and hospitals. These impact on, or overlap with, the care sector. The report is particularly useful as it’s a regular, annual report and so trends can be tracked, and it covers such a wide range of services and providers. In total they inspected over 32,000 services and providers.

What did it find?

The report is split into 4 sections:

  1. People’s experiences of care: overall, the CQC found that, unsurprisingly, Covid had a huge and devastating impact on those who used care services. In particular, the report highlights people with learning difficulties and mental health issues who have struggled to get the care they need. Staff are more exhausted than ever, and if things don’t improve for them the sector will continue to lose staff, to the retail and hospitality industries in particular. However, despite these challenges, those who did manage to access the care they needed often had very positive things to say about it: “In the 2021 GP patient survey, a high proportion of people continued to say that they had a good experience of their GP practice: 83% in 2021, similar to the results across the previous three years. Satisfaction rates for appointment times were improved: 67% compared with 63% in 2020.”
  1. Flexibility to respond to the pandemic: according to the CQC, many people welcomed the move to a more remote mode of GP appointment during the pandemic, but not everyone thought it was a positive step and some struggled to get appointments. The report references research from Healthwatch exploring how and why certain groups are more likely to experience digital exclusion. In hospitals, acute areas which were deprioritised in favour of urgent care have begun to recover, with cancer services recovering best so far. But ambulance handover delays continue to be a real concern, as does access to dentists. The ‘discharge to assess’ model, which has helped health and social care services to make strides towards helping hospital leavers, is not consistently implemented yet.
  1. Ongoing quality concerns: the report notes in particular the risk of ‘closed cultures’ which it has seen in a small number of areas, and especially in mental health care settings. They define a closed culture as ‘a poor culture that can lead to harm, including human rights breaches such as abuse’. In these services, people are more likely to be at risk of deliberate or unintentional harm. Another poor area highlighted is in maternity care, which is suffering from slow improvements, not learning lessons and a lack of engagement with local women. Finally, they express concern about Deprivation of Liberty Safeguards, which too often keep people for longer than necessary due to delays and lack of safeguards.
  1. Challenges for systems: the report was not short of challenges to highlight, many of which existed before the pandemic and have been made worse by it. Areas of concern include poor planning and decision making in the adult social care sector; de-prioritisation of tackling inequalities; and severe problems with recruitment and staff retention. Positive aspects highlighted were shared values, good information sharing, and good communication.

What were the headline figures in the report?

As of 31 July 2021:

  • 80% of adult social care services were rated as good and 5% as outstanding
  • 90% of GP practices were rated as good overall, and 5% as outstanding
  • 67% of NHS acute core services were rated as good and 8% as outstanding
  • 68% of all mental health core services (NHS and independent) were rated as good and 10% as outstanding.

The figures specifically about GP practices were as follows:

What has the reaction been?

Care industry bodies have welcomed that the report lays bare the scale of the issues facing the sector. The Health Foundation, for example, stated that the health and social care workforce may need to grow by up to a million staff by 2030/31 to meet demand. Others said more was needed from government to address the “tsunami of unmet need” this winter. The reality of this is, they say, is that some people will now go without the care they need this winter.

 

What next, and what does it mean for GP surgeries?

On the new money being provided by the government, the report stresses that it can’t simply be spent on ‘business as usual’, saying: “The £5.4 billion investment must be used to enable new ways of working that recognise the interdependency of all care settings, not just to prop up siloed approaches and plug demand in acute care.”

At the report’s launch event, Chief Inspector of Primary Medical Services Dr Rosie Benneyworth explained that the GP inspections going forward would be supportive in nature and ‘focusing on where we hear concerns’. Previously the CQC has also said it has stopped using QOF data to assess practices for ‘at least’ 12 months, because it is ‘not reliable’ and ‘many months out of date’.

Thankfully there is some agreement between this report and the new draft Health and Social Care Bill about the measures which are needed. Both recognise the need to make a step-change in the ways the system works at a fundamental level, using digital and tech, enabling people to work smarter not harder, and to support staff more. The challenge will be moving beyond warm words and good intentions, to tangible differences on the front line, which stand the test of time.


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