This recently published report by CQC makes interesting reading for Adult social care providers.
In Angela Sutcliff’s (Chief Inspector CQC) introduction she acknowledges the efforts of over three-quarters (77%) of adult social care services which are rated good – this she says should be celebrated. According to Sutcliff these are services with leaders who inspire a positive culture focused on providing person-centred care – treating people as people and not just as recipients of care. These leaders motivate, develop and value their staff who work tirelessly and skilfully to support people to live their lives to the full, with dignity and respect.
The CQC initial programme of comprehensive inspections and ratings covered 33,000 care services in all across over a period of two and a half years. However, quality across England is undeniably variable. The initial comprehensive inspection programme found only 2% of services were rated as outstanding. Sutcliff says, “While we make no apology for setting the bar high, this is considerably lower than we originally expected”. “It is clear that it is more difficult to achieve this highest standard of quality.
Readers will be aware that I have long argued in the past that the bar has been set too high and is counterproductive to those providers who need encouragement to improve the quality of services and reach the outstanding grade. I believe that it should be replaced by an excellence model, where the components of an excellent service are clearly identified. These should be free from ambiguity and measurable, and not rely solely on the judgement of an inspector.
Not only would this bring about more clarity it would result in the number of services who achieve the outstanding grading more realistic, without a drop in the definition of what constitutes a high quality social care service.
The report also found evidence of too much poor care: 2% of services are currently rated as inadequate, and 19% of services are rated as requiring improvement and are struggling to improve.
Background
Adult social care is the largest sector that CQC regulates, with a large number and range of providers, a strong private and voluntary sector, and wide differences in the size and types of services and care provided. The sector covers accommodation and personal care provided in residential care homes, nursing homes and specialist colleges (around 16,000 locations, with the capacity to provide care for around 460,000 people).
Personal care provided in the community for more than half a million people, of which the majority is care provided in people’s homes through domiciliary care services (around 8,500 services), as well as extra care housing, Shared Lives schemes and supported living services.
Challenges facing the sector
Adult social care services are facing a number of challenges. These include:
An ageing population with increasing needs.
The number of people aged 85 or over in England is set to more than double over the next two decades.
More than a third of people aged over 85 have difficulties undertaking five or more tasks of daily living without assistance, and are therefore most likely to need health and care services.
Difficulties in recruiting and retaining staff to care for people.
In 2015/16 the overall staff vacancy rate across the whole of the care sector was 6.8% (up from 4.5% in 2012/13), rising to 11.4% for home care staff. Turnover rates have risen from 22.7% to 27.3% a year over the same three-year period.
Potential changes to immigration policy resulting from the vote to leave the European Union could have serious consequences for the social care workforce. Around one in 20 (6%) of England’s growing social care workforce are non-British European Economic Area nationals – around 84,000 people.
Rising costs of adult social care. In 2015/16, the gross expenditure of all councils with adult social services responsibilities was £16.97 billion. Although this is 18% higher in absolute terms than in 2005/06, after accounting for inflation it is 1.5% lower than in that year.
Findings from the most recent Association of Directors of Adult Social Services budget survey have estimated that the National Living Wage will cost councils around £151 million plus at least £227.5 million in implementation and associated costs in 2017/18. This will affect both direct council costs and increased provider fees.
Concerns about funding to meet these costs and a reliance on those who pay for their own care.
Age UK estimates that an additional £4.8 billion a year is needed to ensure that every older person who currently has one or more unmet needs has access to social care, rising to £5.75 billion by 2020/21.
Some providers, particularly in domiciliary care, have withdrawn from local authority contracts where they felt there was too little funding to enable them to be responsive to people’s needs. Despite additional funding that has been made available for adult social care, only 7% of directors of adult social services are fully confident that savings targets will be met in 2019/20. The public have expressed concerns over the higher charges self-funders tend to pay, compared with state-funded residents.
Summary
This report acknowledges the valuable contribution made by 77% of adult social care providers. It also found that 23% are still failing to reach acceptable CQC standards. Given that only 2% of social care services in the sector achieve an outstanding grading, does little to promote quality of care in the sector in the eyes of the general public. The criteria for the award should be replaced by a model of excellence with components that can be subject to measurement. The report outlines the serious challenges that are facing the industry in the future.
Albert Cook BA, MA & Fellow Charted Quality Institute Managing Director Bettal Quality Consultancy