Chris Ham, Chief Executive of The King’s Fund
“It has been clear for some time that cuts in budgets and rising demand for services have left the adult social care system struggling to meet the needs of those who depend on it. This is placing an unacceptable burden on unpaid carers and is leading to rising numbers of people who have difficulty with the basic activities of daily living without any support at all.
“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.
“This is exacerbating pressures on the NHS, as evidenced by the record number of patients who are fit to be discharged but are delayed in hospital. The Government must address the under-funding of social care in the forthcoming Autumn Statement.
“The NHS organisations that are providing high quality care should be congratulated, but it is clear that the severe operational and financial pressures are beginning to take a toll. While this is most visible in acute services, it is also important to highlight the huge pressure on district nursing services, where unmanageable caseloads and shortages of staff risk compromising quality of care, and mental health services, where shortages of beds are making it increasingly difficult to treat patients in crisis.
“It is essential that health and social care organisations work together in a more coordinated way. The new models of care and place-based approaches to planning care now being developed across the country are key to this.
“We also need to recognise that while regulation and inspection are important, on their own they are not enough to ensure high quality care. It is also vital to champion the role of good leadership, a culture of engaging with staff and involving local people in improving services.”
Stephen Dalton, Chief Executive of the NHS Confederation
“The report shows that 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. 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.
“A major concern is the sustainability of social care provision. The CQC report exposes that one consequence of cuts to social care is a ‘race to the bottom’ when awarding contracts to care providers. This means contracts are being handed back and providers withdrawing from this market.”
Dr Anthea Mowat, BMA representative body chair
“Many Trusts are continuing to deliver excellent care in a worsening environment within the NHS. Hospitals are coping with more patients, with more complex conditions, but are not being given either the funding or staff to cope with this rising pressure.
“We need politicians to recognise the strain facing our health service and provide it with the support it needs to deliver the best possible service to patients, especially in adult and social care.”
Dr Richard Vautrey, BMA GP committee deputy chair
“Given the incredible pressure on general practice it is a remarkable level of achievement that close to nine in 10 practices are rated as good or outstanding. This does show that despite rising levels of demand, contracting budgets and staff shortages, GPs are continuing to put their patients first and work harder than ever before to give them a first rate service.
“Those practices that are judged as needing improvement can fall into this category for a number of reasons and most will have already taken steps to make the necessary improvements suggested by CQC.
“No practice that delivers care in an unfit manner would be allowed to remain open. Instead of demonising those practices that are struggling, we do need to ensure that every local GP service is given enough resources and staff so it can meet public demand. This is needed more than ever given we are in a difficult climate where 300 GP practices recently told the BMA they were considering closure because they were no longer financially viable.”
Janet Morrison, Chief Executive of Independent Age, the older people’s charity
“This report is the first time we have had a truly comprehensive picture of what is happening in social care, and it is a grim picture. The report, covering 20,000 inspections, lays bare the fact that nearly one in three social care organisations are rated as needing improvement or inadequate.
“While we recognise that there are examples of excellent practice, it is alarming that weaker care providers are not getting any better. We are seeing services failing, problems recruiting a workforce with the right skills, and providers seemingly resistant to improvement. We need urgent action to address this failing, to ensure that we have a health and care sector where no one is left behind.”
Peter Wyman, Chair of the Care Quality Commission
“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.
“We will continue to highlight good and outstanding care, support improvement and take action to protect people where necessary. And we’ll use the uniquely detailed information we hold on quality to help those that lead, work in and use health and care services to make the right decisions. All of us all want the same thing – good, safe care that’s sustainable into the future”