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Reaction: CQC warns that the future of care is precarious in its annual review

Nuffield Trust Director of Research Professor John Appleby

The report shows that although most NHS patients still receive good and safe care, the system as a whole is struggling to cope. The CQC’s warnings must be seen in the context of the unsustainable financial squeeze. The NHS ended last year with an underlying deficit of £3.7bn and faces an even greater challenge this year.

“If the response to this problem is to try to exert more grip and push harder from Whitehall, it will fail: at this stage staff and leaders can’t work much harder. We need supportive leadership which puts the emphasis on working together to tackle difficult changes.

“Perhaps the most worrying parts of this report touch on social care for older people. One in eight are not receiving the care that they need in the community, and costs have already been pushed so low that companies are giving up contracts. The future funding and organisation of social care is becoming one of the greatest unresolved policy issues of our time, and action on this is now an important priority.”

RCP president, Professor Jane Dacre

“This is yet another report outlining that health and care services are at full stretch, with quality only being maintained because of the tireless efforts of staff. The CQC is right to say services need to modernise, but the elephant in the room is the fact that the Department of Health’s budget is growing, in real terms, at about a quarter of the average since the NHS was established.

“There needs to be the opportunity for innovation, but modernisation cannot happen while staff are working flat out just to keep services running.”

Dr Chaand Nagpaul, BMA council chair

“It is certainly encouraging to see that the NHS is providing good levels of care for patients, particularly in general practice where we know that GPs are consistently under enormous pressure, but it is worrying that almost 1 in 4 acute hospital services and almost a quarter of mental health services are having their performance affected by lack of resources, system pressures and chronic underfunding.

“Now is not the time to rest on our laurels – A&E targets still aren’t being met, the number of people waiting more than 10 weeks for routine surgery is the highest its been in nine years and waits of a year or more are the second highest since 2012. The average waiting time for a GP appointment has hit two weeks, and many surgeries closed altogether last year. Failures within the social care system are also having a considerable knock-on effect on an already stretched and underfunded NHS. When social care isn’t available, patients experience delays in moving from hospital to appropriate social care settings which damages patient care and places a significant strain on the NHS.

“We are just one bad winter away from another crisis in our health system. The government should urgently bring spending on health in line with other leading European economies and produce a long-term strategy that addresses the fundamental workload and funding challenges that are overwhelming our health service.”

Richard Murray, Director of Policy for The King’s Fund

“This report highlights once again that the NHS is under increasing pressure, with demand for services growing faster than funding and with recruiting and retaining staff representing a huge challenge. But while patients are having to wait longer to access care in some cases, it is encouraging that the majority of care that people receive is still good quality. The credit for this goes to the NHS staff whose hard work and commitment often act as shock absorbers in the system, but to expect staff to continue to work harder is clearly not a sustainable strategy.

“The report also shows the continued instability in the social care sector, with wide regional variation in performance and capacity reducing despite increasing demand. We agree that social care is one of the unsolved policy issues of our time, and the forthcoming consultation on social care needs to set out costed options for putting social care on a sustainable footing for the future. It is vital that the government fulfils its manifesto commitment to act ‘where others have failed to lead’ and that other parties approach this in the spirit of cross party consensus that will be needed to affect real and long-lasting change.

“This will mean confronting hard choices about how to pay for this through a combination of private and public funding. As well as increases in tax and National Insurance, this will involve looking at other options such as redirecting public spending for example on winter fuel payments and perhaps Attendance Allowance, and being explicit about the role of housing wealth.”

Niall Dickson, Chief executive of the NHS Confederation

“It would be a tragedy if the NHS’s 70th birthday was remembered as the year England’s care system collapsed, but today’s report reveals real concerns that mental health and social care services are not sustainable. Contracts are being handed back leaving more individuals at risk.

“Let no-one misunderstand what is being said here – the health and care system is managing well, with some improvements in safety, but its future is precarious. And one in eight older people are not getting the help they need.

“CQC has the support and confidence of government yet this message is not a comforting one – once again with herculean effort, leaders and those on the front line have delivered safe services to millions but the pressures are taking their toll.

“Today’s report is unequivocal – the quality of services is in a fragile state as the system strains to treat and support more older people with complex conditions.

“There are fewer nursing home beds and home care contracts are being handed back because there is not enough money to pay for the care that is needed.

“Of course, as the report acknowledges, there is more local services can do to improve co-ordination and the way services are organised, but the inescapable conclusion has to be that without further government funding today’s perilous state will become tomorrow’s tragedy,

“As CQC has pointed out, this is one of the major unresolved public policy issues of our time. It is time government and indeed all the political class woke up to this challenge and accept that if social care goes down, we all go down.”

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