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The state of health care and adult social care in England 2018/19

This latest report by CQC on the state of adult social care in England highlights the ongoing challenges of an industry in decline. The number of nursing and residential homes fell 6% and 11% respectively between 2014 and 2019.

In adult social care, funding and workforce issues continue to contribute to the fragility of the sector. 2018/19 saw providers continuing to exit the market. The situation was so acute that the CQC twice exercised their legal duty to notify local authorities that there was a credible risk of service disruption because of provider business failure.

Lack of a sustainable funding solution

To its credit the CQC continues to warn Government that the continuing lack of a long-term sustainable funding solution for adult social care is having a damaging impact on the quality and quantity of available care. The failure to find a consensus for a future funding model continues to drive instability in the social care sector and there is an urgent need for Parliament and government to make this a priority.

Burden of care

The report draws attention to the burden that is shared by families and carers. The health and care system relies heavily on the work of millions of unpaid carers, as well as the voluntary sector. There are increasing pressures on this vital support network. In its annual survey of more than 7,500 people currently caring unpaid for family or friends (the majority of whom provide well over 50 hours of care every week),

Carers UK found that two in five carers (39%) said they were struggling to make ends meet. More than two-thirds (68%) of carers were using their own income or savings to cover the cost of care, equipment or products for the person they care for, such as nutritional supplements and mobility equipment.

Domiciliary care is not growing fast enough

The domiciliary market is not growing fast enough to meet the increasing demand for services and offset the falling number of nursing and residential home beds, the Care Quality Commission has warned.

CQC chief executive Ian Trenholm said the adult social care system remains fragile and that the domiciliary sector is “particularly unstable”.

The warning comes despite the report showing that the number of domiciliary care services in England has grown 23% to 9,528 since April 2014.

“What the report is showing is a reduction in residential care as people are being maintained in their home for longer. That’s the theory. The practice though is that although the number of domiciliary care services is going upwards, we’re not convinced it’s going upwards fast enough,” said Trenholm.

Kate Terroni, the CQC chief inspector of Adult Social Care, said “What continues to cause us concern is that we don’t think the fall in the number of nursing home beds has been matched by good quality and sustainable domiciliary care.”

Integration of health and social care

According to the CQC when local health and social care providers work well together, people’s experience of care can be improved. They see urgent necessity for change and that the barriers to working together broken down. They have begun to see evidence of more integration and/or joint working emerging. With some local areas showing improvements.

Innovative providers are bringing together nurses, occupational therapists, physio therapists and other carers and these are the ones that are delivering the most effective care.


This latest report by the CQC provides stark evidence of an industry in decline with the accelerated closure of care and nursing homes and a replacing domiciliary care service not able to keep pace with demand. As a consequence, an ever increasing burden is being placed on carers who are struggling to make ends meet.

The drive towards more integrated care is a model I fully support as it results not only in a more effective service, but a more seamless one which must surely benefit those who require services. Among all this doom and gloom I thought I would end on a slightly more positive note. CQC report that 80% of adult social care services were rated as good and 4% as outstanding. We all welcome this achievement but there is still some way to go.

Albert Cook Albert Cook BA, MA & Fellow Charted Quality Institute Managing Director Bettal Quality Consultancy

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