The report underscores that increasing living expenses and a lack of staffing are causing prolonged wait times and reduced accessibility to care services.
Care provider organization The Independent Care Group (ICG), said the country deserves better than a two-tier system of social care.
ICG Chair Mike Padgham said: “We must not move fully into a system where if you can buy your own care, you can have it but if you rely on your local authority, you can’t.
“Today’s report from the CQC shames us as a country and exposes the cruel, two-tier system of social care of haves and have-nots that we have been warning would come for years.
“If this continues, more and more providers who rely on local authority residents and homecare contracts will fail or close down, leading to an even greater shortage of care provision. Older and vulnerable people deserve better and deserve to have the care they need, when they need it.
“This is just the latest in a long line of damning reports and we can only hope that one day the Government will read one of them and wake up to the fact that something needs to change.”
Under Investment
Matthew Taylor, chief executive of the NHS Confederation said: “This sobering report lays bare the critical state that the NHS is in and should provide a salutary warning to political leaders about the abundance of issues facing the health service and the scale of the recovery task ahead.
“After a decade of under-investment in staff, buildings and infrastructure, it is no surprise that we are in this position. We now need a credible plan that helps NHS leaders recover services and rebuild public confidence in what has always been one of the UK’s most valued institutions.
“The report is rightly at pains to point out that there is good work happening across all of the sectors in very tough conditions, particularly around mitigating the risks of staffing shortages, but health leaders will all too readily recognise the many intractable problems outlined within it.
“This should make for deeply uncomfortable reading for the government, with crises on multiple fronts meaning much more help is needed if the gridlocked care system is to have any hope of getting back to where it was in terms of performance a decade ago.
“This report suggests that those who can afford it are increasingly turning towards private care, creating the risk of widening access gaps towards a future two-tier healthcare system, or the impact of the cost-of-living crisis on patients, providers and exhausted, stressed staff – whose satisfaction with levels of pay has dropped twelve percentage points since before the pandemic.”
Damning Picture
Vicki Nash, Associate Director of Policy and Campaigns at Mind, said: “This report paints a damning picture of the situation in mental health services. Sadly, the scale of the crisis comes as little surprise to those with experience of mental health problems or working on the frontline. The findings sound alarm bells across the board – from quality and safety of care, through to waiting lists, capacity and staffing. These failings are systemic, and, despite repeated calls for investment and improvement, services are now buckling under the pressure.
“It is clear the mental health system is broken – people seeking help are being let down and even losing their lives in the process. They might be one of the eight million people struggling with their mental health who can’t access support, among the 1.8 million on waiting lists for community care or receiving hospital treatment that is substandard and unsafe. We know many people’s mental health deteriorates while waiting and can reach crisis point before they get help, meaning they are left with no alternative but A&E, detained against their will for treatment, or fall through the cracks between different overstretched agencies. This cannot go on. The UK government must urgently raise the standard of mental health care”.
Ongoing Strains
Responding to the Care Quality Commission’s annual State of Care report, Dr Jennifer Dixon, Chief Executive of the Health Foundation, said:
‘Today’s CQC report is further proof of the urgent need to invest in the NHS and social care workforce – or see many more people go without the care and treatment they need as services struggle to meet demand and address the backlogs created by the pandemic.
‘The CQC highlights how the pandemic has left health and care staff stressed, overstretched and exhausted. Increases in vacancy rates are already affecting access to high-quality care, particularly in social care and other services that support some of the most vulnerable in our society. This winter is set to test the health and care system like no other. Expecting health and care staff to keep going above and beyond, under the most intense pressure, is simply not sustainable.
‘Even before COVID-19, a decade of underfunding and understaffing had undermined the resilience of the NHS and led social care to the brink. With demand for services expected to increase, the health and social care workforce may need to grow by as many as a million staff by 2030/31. This includes a 40% increase in the health care workforce, more than double the growth for the NHS over the last decade.
‘The forthcoming spending review is an opportunity to drive long overdue action on workforce planning and supply. The government needs to invest in the training, recruitment and retention of NHS staff, while finding the extra funding needed to ensure more people can access high-quality social care. This will only be delivered if the sector can offer the pay, terms and conditions that enable staff recruitment and retention.’
Care Not being Met
Sally Warren, Director of Policy at The King’s Fund said: ‘This comprehensive report reveals the sad reality that the quality of care that patients need and deserve is not being met in many parts of the NHS and social care. The analysis makes it painfully clear that inequality in access to care and in health outcomes is still rife.
‘Public satisfaction with the NHS is at a record low. Despite this, and despite signs that some people are paying for care out of their own pocket while others simply go without, public support for the founding principle of services being free at the point of use remains rock solid. History has shown us that a slow slide towards a two-tier health service can be avoided through a concerted effort to bring down NHS waiting lists, led and funded by government.
‘The challenges in social care are in many ways more acute. More people are requesting social care support but fewer people are getting it, local authorities can’t afford to pay providers for the quality services that are required, and public satisfaction has slumped to desperately low levels. The current model of social care in England is not fit for purpose and reform is long overdue.
‘The report shows the multiple crises the government will have to address if it wants to get health and care services back on track. Achieving that will require bold action to prevent illness, measures to make health and care a more attractive career, and bolstering out of hospital care such as GP, community and social care service.
‘The report also highlights key areas where leaders across the NHS need to take action to ensure an equitable, fair and compassionate culture across their local teams, organisations and systems. Examples stretching from racial stereotypes in maternity care, or inappropriately restraining patients in mental health settings, shows that leaders have work to do to create a culture focused on ensuring teams are enabled to treat all patients with care, compassion, dignity and fairness.’
Widening Inequality
Carers Trust’s CEO, Kirsty McHugh, said: “The challenges facing social care laid out in this alarming report are having a huge knock-on effect for millions of people who have to look after their loved ones at home. These family carers are essentially an unpaid workforce who are propping up a struggling system. This is leaving them particularly vulnerable to the cost-of-living crisis and forcing many into poverty, widening the inequality highlighted by the CQC.
“As this report recognizes, local authorities have a clear legal duty to identify, assess and support unpaid carers. Too often, however, carers are being starved of vital support and access to care because of vast differences in carer strategies across the country. It is absolutely vital that the needs of this country’s unpaid carers are properly addressed and those responsible for supporting them are held to account. Carers Trust and its network of local care organizations look forward to working with local authorities and integrated care systems to ensure this happens.”
National Care Service
The ICG is campaigning for the merging of NHS healthcare and social care to create a National Care Service. It argues that money saved by supporting social care and keeping people out of hospital would help fund improvements to the social care system. Social care needs a minimum of £7bn extra a year just to keep pace and the sector is desperate for help to properly reward its workforce and tackle the ongoing staff shortages.
“Money saved from unnecessary hospital care can be switched to properly fund social care and to meeting current and future demand, so the cost to the public purse might not be as high as people are fearing,” Mr Padgham added.
“We cannot wait, even until a General Election, for reform to begin. The warning is there: we are slipping towards a two-tier system, more and more people are living without care, providers are closing and people are still having to sell their homes to pay for care.
“The case for reform is now overwhelming, we need our politicians to be brave and get on with it.”
Gridlock
Professor Martin Green OBE, Chief Executive of Care England, says: “The ‘gridlock’ which characterised the health and social care system last year has been aggravated by new pressures for care, including inflation, the cost of living and ongoing challenges with the workforce.
“Despite 70,000 new international workers in the care sector across 2022 – 2023, resulting in a net reduction of 13,000 vacancies, we have lost 57,000 domestic workers. This is not sustainable. Without central Government intervention, we may not be looking at gridlock next year, but a total impasse.”
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