Yet again the Care Quality Commission’s (CQC) annual report “The state of health care and adult social care in England 2022/23”, makes for grim reading whether you are a care user or provider.
The headlines for social care will come as no surprise to those of us working in the sector with reports of insufficient capacity, staffing and financial pressures and knock-on effects on people’s care. As a result of increased pressures on providers and staff, the report identifies how the mental health and wellbeing of staff continues to be a concern.
Many providers report they are struggling to pay staff a wage that keeps pace with inflation and as a result are experiencing difficulties in recruiting and retaining staff – although the statistics don’t bear this out, with staffing vacancies in the care home sector having dropped from 11% to 7% since the publication of the previous report.
Access to Care
There are few things more distressing than people than waiting for treatment or to move on from a place of treatment back to home or to residential accommodation. Despite improved occupancy rates, 84% up from 82% in the last report, the number of available beds for social care has dropped 0.6%, almost 3000 beds, in the same period. This means the sector is increasingly being pushed to provide more but with less resources.
To put this in some sort of perspective, since 2017/2018 new requests for adult social care have increased by 5%. Notably the majority of this increase is accounted for by people of working age, with the level of demand from older people remaining relatively stable.
The lack of capacity in residential and home care settings is leading some providers to think twice about accepting additional referrals from the hospital setting as many do not have the human resources, staff, to be able to provide safe care. This in turn is leading to delayed discharges from hospital, a lack of hospital beds for active treatment and greater waiting times for planned care and treatment, with over 7 million people on elective waiting lists as of June 2023.
Quality of Care
Of note, the pressures faced by the adult social care sector have had limited impact on the CQC’s ratings of the quality of care. As the following table shows, the vast majority of providers are rated good or outstanding with only a small percentage increase in the numbers rated as requires improvement.
While having nothing specific to say about adult social care, the report highlights ongoing issues with access to care, as well as the manner in which treatment is delivered, for people from ethnic minority groups.
People living with learning disability and autistic people report inconsistencies in care and outcomes of care in supported living services which is, at least in part, related to a reduction in funding, in real terms, in the sector which “mean that budgets are prioritised above truly person-centred approaches to supporting people.”
Deprivation of Liberty Safeguards (DoLS)
What is most notable in this section of the report is the massive increase in the number of applications for DoLS in adult social care between 2020/21 and 2022/2023, from around 67,000 to well over 80,000. This has inevitably led to increasing delays in local authority assessments of applications and the knock-on effect that many people face restrictions to their liberty without the requisite authorisations being in place.
While this is not a new phenomenon for the sector, it does raise significant questions for providers who may be faced with uncertainties about both new applications and expired authorisations and where they stand legally when depriving people of their liberty while waiting for an assessment.
The adult social care workforce
While vacancy rates in adult social care (ASC) staffing are dropping, many providers, perhaps being exhausted after the challenges of the last few years, are still reporting significant challenges with recruiting and retaining staff.
In some part this retention issue is driven by the impact of the cost-of-living crisis which has squeezed provider budgets, as well as those of staff, meaning they are not able to afford to pay care staff wages which even equal those which staff might receive if they moved to the retail sector (an average of £10.03 per hour versus £10.12). Perhaps the biggest challenge lies in turnover rates in ASC which remain high at about 29% which causes providers to spend time and money on recruitment, Disclosure and Barring Service checks and additional training etc. when the money might be more usefully spend increasing wages and on other retention initiatives.
The report highlights the role of integrated care systems (ICSs) along with their respective integrated care boards (ICBs) in tackling some of the challenges faced by local health and social care providers. Notably the report identifies that over one third of adult social care providers felt that their local boards failed to consult with them at all.
Once again the CQC’s State of Care report makes challenging reading for all providers of social care. As expected the main focus is on NHS provision, despite the fact that more people are supported by, and work in social care. Once again the report continues to highlight the challenges that face the wider health and social care system.
In their summation of the report, Care England, identify that the current “gridlock” is unsustainable and that growing capacity in social care has to be seen as a priority for funding, alongside realistic wage increases for social care staff. Ever has it been thus.
As social care providers face the ongoing challenges, it is good to know that there is no need to be concerned about the need for high quality policies, procedures and documentation. To find out how Bettal’s can help your business with our CQC-compliant quality management system, browse our website, or get in touch:
Peter Ellis MA MSc BSc(Hons) RN
Bettal Quality Consultancy