Introduction to the report
The CQC report covers NHS services as well as social care for adults and children. In his introduction to the report, Chair Ian Dilks OBE says:
Across our activity and analysis, it is clear that timely access to good care continues to be a struggle for many, and that inequalities in care persist. For example, in March 2024, 5 million people waited more than 2 weeks for a GP practice appointment, with 1.4 million waiting more than 4 weeks. The number of new requests for local authority adult social care support that resulted in no service being provided has increased by 27% over the last 5 years. In April 2024, waits for care home beds and home-based care accounted for 45% of delays in discharging people who had been in an acute hospital for 14 days or more, with nearly 4,000 people delayed on an average day.
And issues with getting access to services are often exacerbated by deprivation: in 2023/24, attendance rates for urgent and emergency care for people living in the most deprived areas of England were nearly double those for people in the least deprived areas. Furthermore, analysis conducted for CQC showed that for people attending for mental health reasons, the difference was over 3 times higher for those in the most deprived areas.
Summary of adult social care
In the summary of their findings in adult social care, the report states
The need for social care continues to increase, including needs when people are discharged from hospital. However, supply has not always kept pace, meaning more people are not getting the support they need.
The increase in the number of new requests for local authority adult social care support in 2022/23 was not matched by the number of requests granted with long-term care or short-term care to maximise people’s independence. The number of new requests that did not result in a service being provided increased by 27% since 2017/18.
In April 2024, waits for care home beds and home-based care accounted for 45% of delays in discharging people who had been in an acute hospital for 14 days or more, with nearly 4,000 people delayed on an average day. Although some of these delays will have involved waits for health rather than social care services, social care is likely to have been a significant factor in these delays.
For much of 2023/24, the North East and Yorkshire region had the highest proportion of delayed acute hospital discharges due to waiting for home-based care, and the North East region had the fewest homecare services per 100,000 population of older people. Meanwhile, London had proportionally the most delayed discharges from acute hospital due to waiting for a bed in a care home, and the fewest residential care home beds per 100,000 population of older people.
At 5.4%, staff vacancies in care homes at the end of 2023/24 were at their lowest rate for the last 3 years. Increases in international recruitment showed signs of levelling off over 2023/24, and there has been a steep fall in the number of overseas workers applying for health and care worker visas – representing an 81% decrease in the period April to July 2024 compared with the same period in 2023.
In 2023/24, we made 106 referrals to partner agencies regarding concerns about modern slavery and labour exploitation – nearly 3 times as many as last year.
Despite the challenges described in our report, outstanding adult social care providers are putting people at the heart of all decision making. Person-centred care, delivered with compassion and integrity, still makes a big difference to people’s lives.
Response of the National Care Forum to the report
The National Care Forum (NCF) – the leading association for not-for-profit social care has responded to the publication of the Care Quality Commission’s report on the state of health care and adult social care in England for 2023/24.
This year’s report builds on the grim picture from last year about the state of the health and social care system with people struggling to access basic health and care services when and where they need them. The report draws attention to growing inequalities in care provision, with particular areas of concern including the quality of mental health services, the experiences and poor outcomes for autistic people and people with learning disabilities, the struggle of children and young people accessing any services in a timely way, and workforce shortages.
In adult social care, unmet need continues to grow as the increase in the number of new requests for local authority adult social care support was not matched by the number of requests granted. In fact, the number of new requests that did not result in a service being provided has increased by 27% since 2017/18. This has had a knock-on effect, with waits for care home and home-based care support accounting for 45% of delays in discharging people from hospital, and doubtless many more people unsupported to live the lives they want to live in the community.
While vacancy rates have improved in adult social care, this was in large part thanks to international recruitment which has seen an 81% drop between April and July 2024 compared to the previous year – this is not a sustainable situation.
Vic Rayner, NCF CEO commented:
“This year’s CQC report, like so many others, highlights the real impact on people when social care is underfunded and under resourced.
“If the government is serious about a three-fold shift from hospitals to community, sickness to prevention and analogue to digital, it must invest properly in the community services that people need to live well, including adult social care. When resourced and organised properly, adult social care enables people to live the lives they want, supports them to access wider community and health services at an earlier stage and helps them retain their independence for longer in strong communities – this ultimately reduces demand on acute services.
“Investment in the care and support workforce will be critical for this, and we again urge the government to adopt the workforce strategy for adult social care facilitated by Skills for Care and developed in collaboration with a wide range of organisations and people with a stake in the future of care services.
“Finally, the report makes no reference the sharp focus that there has been on the CQC’s regulatory function itself. There is no mention of Dr Dash’s review, Professor Sir Mike Richard’s review of the Single Assessment Framework or the work being undertaken by the Care Provider Alliance to understand the care provider perspective on assessment. Clearly, a well-functioning regulator and framework for assessment is one of the requirements for a well-organised and resourced health and social care system. There is much work to be done to achieve this.”
*CQC report
The Care Quality Commission, or CQC is the independent regulator of health and adult social care in England.
Their purpose and role is to make sure health and social care services provide people with safe, effective, compassionate, high-quality care and they encourage care services to improve.
The organisation monitors, inspects and regulates services and publish their findings. If the CQC find poor care, they will use their powers to take action.
All the BCOP nursing homes are inspected by the CQC and you can find their reports on our website pages here:
BCOP is a member of the National Care Forum.
