While the majority of services are safe and of a high quality and many are improving, too many people across England are living in care homes and receiving care and support in their own homes that is not good enough. Without a proper recognition of the importance of adult social care and a renewed commitment to quality, the numbers of people affected by poor care could increase and have a profound impact on their lives.
In a national report, published today, the Care Quality Commission (CQC) has found that over three-quarters of adult social care services are currently rated as Good (77%, 16,351) and 2% (353) are currently rated as Outstanding.
CQC has found that strong leaders – both at provider and registered manager levels – play a pivotal role in high-performing services, where a strong vision and person-centred values inspire staff, encouraging a culture of openness and transparency. Staff members are capable, confident and caring and are focused on supporting people to live the best lives they can.
However, CQC has found considerable variation with nearly a fifth (19%, 4,073) of services being rated as Requires Improvement and 2% (343) as Inadequate.
This is the first time that such focused analysis on a national scale has been possible following the formal introduction of CQC’s new regulatory regime for adult social care in October 2014, with expert-led, specialist inspections that focus on what matters most to people using services – are they safe, caring, effective, responsive and well-led? CQC then rates services as Outstanding, Good, Requires Improvement or Inadequate so that the public and providers are clear about its judgements.
Since then, CQC has carried out over 33,000 inspections of around 24,000 different services – many more than once. These include residential homes, nursing homes, care in people’s own homes, Shared Lives schemes and supported living services. These are vital services for thousands of people, young and old, who may be living with a physical disability, learning disability, autism, dementia and/or mental health conditions.
CQC found the adult social care sector performed best in how ‘caring’ its services were, with 92% being rated as Good and 3% as Outstanding in this key question. In these services, CQC found staff building meaningful relationships with the people who they care for over time and treating them with compassion, kindness, dignity and respect.
Safety is where CQC has found its greatest concerns, with 23% of services being rated as Requires Improvement and 2% as Inadequate in this key question. Issues uncovered by CQC include ineffective systems and processes for managing medicines or determining staffing levels, which can result in people not getting their prescribed medicines, call bells not being answered, and home visits being rushed or missed.
CQC has used its inspections and ratings to help providers of adult social care understand the specific areas where improvements are needed, to hold them to account to make these necessary changes, to celebrate best practice and to help people to make informed choices about their care.
Already, CQC’s actions are driving improvements in care for people. Of the 686 services that were originally rated as Inadequate and have been re-inspected, more than four in five (81%, 553) improved their overall rating. However, this does still mean that nearly a fifth of services have not improved and further action is required.
CQC has not seen the same rate of improvement in services that were rated as Requires Improvement initially, where only 56% of the services eventually improved to Good, with others failing to improve and some deteriorating.
Worryingly, 26% of the services that were first rated as Good and have been re-inspected have deteriorated. While these are a small proportion of services that were originally rated as Good, it shows that providers cannot always sustain this level of good practice within their services and that as a whole; the sector continues to be fragile at a time when more people are expected to need its services.
Andrea Sutcliffe, Chief Inspector of Adult Social Care at the Care Quality Commission, said: “When CQC began to transform its regulation of adult social care in England, I asked my staff to consider whether every service they were inspecting was good enough for their Mum or anyone they loved. The ‘Mum Test’ has guided our work ever since and made sure that we always focus on the people who are most important – people who use services, their families and carers.
“Having carried out over 33,000 inspections of around 24,000 different services, most of the adult social care sector is meeting the Mum Test, providing safe and high quality care that we would be happy for anyone we love, or ourselves, to receive. This is thanks to the thousands of dedicated staff and providers who work tirelessly to ensure people’s care is truly person-centred and meets their individual needs.
“However, there is still too much poor care, some providers are failing to improve, and there is even some deterioration. “It appears to be increasingly difficult for some providers to deliver the safe, high quality and compassionate care people deserve and have every right to expect. With demand for social care expected to rise over the next two decades, this is more worrying than ever.
“Last October, CQC gave a stark warning that adult social care was approaching a tipping point. This was driven by more people with increasingly complex conditions needing care but in a challenging economic climate, facing greater difficulties in accessing the care they need.
“While this report focuses on our assessment of quality and not on the wider context, with the deterioration we are seeing in services rated as Good together with the struggle to improve for those with Inadequate and Requires Improvement ratings, the danger of adult social care approaching its tipping point has not disappeared. If it tips, it will mean even more poor care, less choice and more unmet need for people.
“The announcement in the Chancellor’s budget statement of £2 billion additional funding over the next three years is welcome but even more welcome is the promise of a Government consultation this year, which hopefully will lead to a long-term solution to support good quality, person-centred adult social care, both now and into the future.
“Quality must be at the heart of the long term reform of social care in England. CQC will continue to keep its relentless focus on quality with regulation becoming more targeted, risk-based and intelligence-driven over the next few years. But we cannot do it alone. Everyone must play their part in making sure quality matters and that adult social care services provide care that we would all be happy to use.”
Nick Sanderson, CEO, Audley Retirement Villages said:
“The social care shortfall is edging ever closer to a full blown crisis and we now find ourselves in a situation where underfunding is at such a critical point, the quality of care itself is falling. More than ever people are having to watch their loved ones experience an appalling quality of care; just further evidence that existing care practices are both undesirable and deeply flawed.
“There may be no ‘one answer’ on how we deal with the creaking care system, but we do know that high quality housing options with flexible care available is a model that works. No matter what their age or care needs, people clearly prefer to be at home as they age, rather than in a nursing or care home. If there were more options which allowed older people to continue to live in their own homes, but bring in support where needed, it would go a long way to improving quality of life. It’s certainly no quick fix, but we need to stop wringing our hands and ignoring the benefits that high quality retirement property delivers.”
Commenting on CQC’s Annual Report Professor Martin Green OBE, Chief Executive of Care England said:
“The report indicates that although progress has occurred there is much to be done in order to ensure that all providers are in a position to provide the best quality care; getting to grips with the fees from local authorities and CCGs is key to this objective. Care England welcomes the report and the intelligence it provides will ensure CQC and providers can work to see a social care sector that can achieve the high ambitions it sets itself for good quality and personalised care”.
CQC’s report comes at a time when the sector has been under the microscope. Care England, the largest representative body for independent providers of social care, is anxious that this momentum is not lost and that the promised Green Paper does not morph into yet another consultation. There have been endless reviews and consultations; action is needed now.
Professor Martin Green continued:
“This sector is still at a tipping point. In order for this to be alleviated the resource, including the newly pledged money from the Government, needs to be delivered to the front line. This is not always happening and action must be taken to address this by Government”.
VODG encourages providers and commissioners to use CQC’s latest evidence to make a continued step up in quality
Commenting on the publication VODG chief executive, Dr Rhidian Hughes said:
“This report provides a welcome, authoritative, contribution on the state of adult social care. At a time when the sector is being financially pushed to the brink, CQC’s assessments on the quality of care have never been so important.”
He goes on to say:
“The vast majority of services are good and this is a great credit to the sector’s workforce. But there remains considerable variation in quality across the market and it is unacceptable that some people find themselves exposed to poor and inadequate services. VODG is encouraging providers and commissioners to use CQC’s evidence to inform a continued step up in quality, and to share what works well across the sector.”
Caroline Abrahams, Charity Director at Age UK said:
“The inspectors say a fifth of all services are not good enough overall and, even more alarmingly, that a quarter of services are insufficiently ‘safe’, so this means older people are now effectively playing ‘Russian Roulette’ when they need care.
“It is also extremely troubling that a quarter of all care services rated as ‘Good’ and then re-inspected have since declined.
When significant numbers of previously effective providers are unable to sustain a quality care service you know the system’s in serious trouble.
“Taken as a whole, this report is a graphic demonstration of why older people desperately need the Government to follow through on its commitment to consult on proposals for strengthening social care later this year. The report also makes a compelling case for why considerably more investment in social care is required.”
In response Nicola O’Brien, Head of Policy and Campaigns at Alzheimer’s Society, commented: “Alzheimer’s Society has persistently highlighted the urgent need to improve the quality of care for people with dementia. Twelve months after the last CQC report warned that we had reached a “tipping point”, the situation for hundreds of thousands of people with dementia is now even worse.
“It is disturbing that safety has been flagged as the biggest concern in care, when providers are caring for some of the most vulnerable adults in society. Too often we hear the consequences of inadequate care – our investigation last year revealed people with dementia left in soiled sheets, or becoming ill after eating out of date food, and that only a third of homecare workers have received dementia training, leaving families fearing for their loved ones.
“People with dementia deserve better. Without funding to put the right protocols in place, it’s no surprise that providers are being forced to cut corners. We need to see Government act before the care system collapses, with clear detail on consultation for reform that is backed up with action, not more words.”
Margaret Willcox, President of the Association of Directors of Adult Social Services (ADASS), said: “This report recognises that there is a lot of great care provided by committed leaders and staff through high quality services to people in care homes and in their own home.
“Our recent 2017 budget survey shows that whilst extra funding is very welcome, it doesn’t meet increasing needs and costs, that 74 per cent of directors report that providers face quality challenges and that 69 per cent of councils had experienced provider failure or returned contracts.
“The risk of adult social care approaching its tipping point is still real and we will focus on re-doubling our mutual efforts to ensure that the quality of care doesn’t deteriorate and that older and disabled people and their families get the reliable, personal care they need and deserve.”
Nigel Ellis, Chief Executive at the Local Government and Social Care Ombudsman, said:
“We welcome the CQC’s report into the standard of adult social care nationally. As the Local Government and Social Care Ombudsman we investigate complaints about adult social care, and work closely with CQC to inform their inspection work by sharing information about our investigations into care providers when things go wrong.
“Because of this we believe a key factor in any well-run service is an encouraging attitude to complaints. Care users and their families should be confident to raise concerns about the care they receive, that those concerns are listened to and providers use the learning from those complaints to inform their own service improvements.”