Working together to ease the gridlock

Ian Trenholm, Chief Executive of the Care Quality Commission discusses some of the key messages from our recent State of Care report.

Collage of pictures to demonstrate CQC’s State of Care report

We recently published State of Care 2021/22. This report is our annual assessment of health and social care in England. It presents the insights, trends and themes from the findings from our inspection activity, information from the public and those who deliver care, and other evidence.

You have hopefully seen our main message from this year’s report, but it bears repeating: the health and care system is gridlocked, and it is unable to operate effectively.

This means that people are stuck. They’re stuck in hospital because there isn’t the social care support in place for them to leave. They’re stuck in emergency departments waiting for a hospital bed to get the treatment they need. And they’re stuck in their homes waiting for ambulances that don’t arrive because those same ambulances are stuck outside hospitals waiting to transfer patients.

Workforce challenges

But why is this happening? One of the main reasons is because of a depleted workforce.

The NHS is carrying 132,000 vacancies. This is nearly 10% of its entire workforce, and the highest level in the last 5 years.

We’ve seen a 10% reduction in the ratio of fully qualified GPs per 100,000 patients. This is a complicated statistic, but ultimately explains why people report difficulties in accessing GP services.

And there are 165,000 vacancies in adult social care alone.

Put that together, and we get a figure of around 300,000 extra people that are needed just to plug the gaps across health and social care. That’s around the population of Newcastle.

There’s a human cost to these facts and figures. It means people can’t get GP or dentist appointments when they want them. There are long waits in A&E. It’s taking too long for people to get through the NHS 111. People are waiting in ambulances, and once they’re in hospital, they can’t leave when they’re medically fit because the right support isn’t available.

There’s also an economic challenge. We all know people who are waiting for an operation. This results in people needing to take time of work, either while they’re waiting for treatment, or people who need to take time off to care for loved ones.

Areas of concern

In State of Care we highlight two specific areas of concern, both of which we’ve talked about in previous years.

Maternity care

The key message is that maternity services still aren’t good enough, but this masks some significant inequalities. One of the starkest statistics is that Black women are 4 times more likely to die in pregnancy and childbirth than White women. For Asian women it is 2 times more. Mortality rates remain higher for Black or Black British babies and Asian or Asian British babies. This cannot be acceptable.

People with a learning disability and autistic people

Care is still not good enough. Despite multiple reviews and reports over decades, people continue to face huge inequalities when accessing and receiving health and social care. Two years ago, our Out of sight — Who cares? report shone a light on the consequences of people not getting the right care and support in the community when they need it. It made 17 recommendations for change. Earlier this year, a review on progress on these recommendations found that of these 17, just 4 had been partially met and 13 had not been met.

Points of light

Despite the challenges, we do see fantastic efforts on a daily basis. We see people that are trying to deliver great care but are struggling to do so in a gridlocked system.

As we go around the country, we see lots of good ideas and examples of innovation — points of light. How can these points of light be joined up and scaled?

We think there’s a role for system leaders here. As well as an opportunity for systems to improve how they use data to coordinate services and address inequalities. But as the regulator, we also have a role to play. New powers in the Health and Care Act relating to system oversight will allow us to hold integrated care systems to account and assess how local authorities are delivering against duties under Part 1 of the Care Act. We’ll be looking for system leaders to demonstrate a strong understanding of their local populations to address inequalities and improve access.

The time is now

We talk a lot about the challenges facing health and social care. Although they might not differ to challenges other people are highlighting, we’ve heard how important it is that we — as the independent regulator — add our voice.

A lot of these challenges are driven by historical underinvestment. The focus must now be on long-term planning and sustainable investment.

We need a step-change to attract and retain staff. Better pay is part of the story, but so is training and a positive work environment. How do we inspire people to want a career in health and social care?

Health and social care as a sector is competing with hospitality and retail, who are all paying higher wages. As the cost of living crisis deepens, people will make choices about where they work. In many cases that won’t be in health and social care.

There are no quick fixes, but steps can be taken now by national leaders. Steps on planning, investment and workforce to help stop things getting worse and set the context for local leaders to operate. Local leaders have the power to bring things together, to collaborate, and to support people working in health and social care to deliver the joined-up, high quality services that everyone in this country deserves.

Block letters reading ‘State of Care’

Visit our website to read State of Care 2021/22 in full

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Care Quality Commission

We make sure health and social care services provide people with safe, effective, compassionate, high-quality care and we encourage care services to improve.