State of Care
Ian Trenholm, Chief Executive at the Care Quality Commission
Our annual assessment of the quality of health and social care in England, State of Care 2017/18, has now published.
This year’s State of Care is a story of contrasts, highlighting both the resilience and the potential vulnerability of the health and care system.
I would like to thank everyone who works and volunteers across the many health and social care services where good, safe care continues to be delivered despite the challenges around demand and funding, coupled with significant workforce pressures across all sectors.
However, although quality has been largely maintained, and in some cases improved, from last year, it is also clear that access to good care increasingly depends on where in the country you live, what care needs you have and how well your local health and care system works together — an ‘integration lottery’.
Local systems are made up of a variety of services which in turn make up a person’s experience — not as individual episodes of care, but as part of their health and social care journey.
We know that ineffective collaboration between local health and care services can result in people not being able to access the appropriate care and support in the community that would avoid unnecessary admissions to hospital.
This leads to increased demand for acute services, with the most visible impact of this being pressure on emergency departments. July 2018 saw the highest number of attendances on record, and emergency departments are the core hospital service most likely to be rated requires improvement (41%) or inadequate (7%).
A struggling local hospital can be symptomatic of a struggling local health and care system.
In order to relieve this pressure, we need to make sure that people are supported to live well at home.
I am sure none of us would disagree that it is not good enough that people who need the support of mental health services find it difficult to access or must travel unreasonable distances to get it; that children and young people are ‘at crisis point’ before they get the specialist care and support they need, with average waiting times varying significantly according to local processes, systems and targets, and that one in seven older people are living with an unmet care need.
However, despite these concerns, there is cause for optimism. Some local systems are working together, pooling resources to achieve common goals and deliver high quality personalised care, and technology is improving person-centred care.
We need to work together to support effective collaboration between health and social care services, however, the continued fragility of the adult social care market poses a threat to this, with providers closing or ceasing to trade and contracts being handed back to local authorities.
Two years ago, we warned that social care was approaching a ‘tipping point’. As unmet need continues to rise, this tipping point has already been reached for some people who are not getting the good quality care they need.
It is increasingly clear that without a long-term funding settlement for adult social care, the additional funding for the NHS will be spent treating people with complex conditions for whom care in the community would have been more effective both in terms of their health and wellbeing and use of public money.
There need to be incentives that bring local health and care leaders together, rather than drive them apart.
The challenge for Parliament, national and local leaders and providers is to change the way services are funded, the way they work together, and how and where people are cared for and supported.
The alternative is a future in which care injustice will increase and where some people will be failed by the services that are meant to support them, with their health and quality of life suffering as result.
I am sure the findings and messages in the State of Care report will resonate with many of you, and hope you find it an interesting read. Let us know your thoughts by joining the conversation on Twitter using #StateOfCare.