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Adult social care in trouble and damaging acute care, regulator warns

The sustainability of the adult social care market is approaching a tipping point and its damaging the performance of the NHS, says the CQC.

The regulator’s data shows that a five-year period of steady increase in the number of nursing home beds – going from 205,000 beds in 2009 to 224,000 beds in March 2015 – has now stalled, with numbers remaining static since that time.

Already CQC has seen examples of providers starting to hand back contracts as being undeliverable; and local authorities warn of more to come.

This is due to pressures on fees that funders of care are able or willing to pay, and cost pressures that include the impact of the national living wage (introduced in April 2016).

In 2015, Age UK estimated that more than a million older people in England were living with unmet social care needs (such as not receiving assistance with bathing and dressing); a rise from 800,000 in 2010.

The number of older people receiving local authority-funded social care fell 26% from more than 1.1 million in 2009 to around 850,000 in 2013/14. Also, 81% of local authorities have reduced their real-term spending on social care for older people over the last five years.

The fragility of the adult social care market is now beginning to impact both on the people who rely on these services and on the performance of NHS care.

The combination of a growing and ageing population, more people with long-term conditions, and a challenging economic climate means greater demand on services and more problems for people in accessing care.

This is translating to increased A&E attendances, emergency admissions and delays to people leaving hospital, which in turn is affecting the ability of a growing number of trusts to meet their performance and financial targets.

This view is based on the evidence of inspections, information received through CQC’s market oversight function, and a variety of external data.

The CQC argues that inspection is working. Three-quarters (76%) of NHS services, care homes, general practices and other services that had been rated as ‘inadequate’ by CQC were able to improve their ratings following re-inspection.

Twenty three per cent went from ‘inadequate’ to ‘good’ and 53% went from ‘inadequate’ to ‘requires improvement’.

The regulator found too much acute care that has been ‘inadequate’ – particularly urgent and emergency services and medical services. It will be increasingly difficult for NHS trusts to make improvements to these services unless they are able to work more closely with adequately funded adult social care and primary care providers.

David Behan, chief executive of the Care Quality Commission, 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.

“While there are no easy answers or quick fixes, what distinguishes many of the good and outstanding services is the way they work with others – hospitals working with GPs; GPs working with social care and all providers working with people who use services. Unless the health and social care system finds a better way to work together, I have no doubt that next year there will be more people whose needs aren’t meet, less improvement and more deterioration.”

On the positive side:

  • 71% of the adult social care (ASC) services that CQC had inspected were rated ‘good’ and 1% were ‘outstanding’;
  • 83% of the GP practices inspected were ‘good’ and 4% were ‘outstanding’; and
  • 51% of the core services provided by NHS acute hospital trusts were ‘good’ and 5% were ‘outstanding’.

However, some people still received very poor care; 2% of adult social care services, 3% of GP practices and 5% of hospital core services were rated ‘inadequate’.

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