The state of care at a time of crisis

The State of Care report is the Care Quality Commission’s (CQC) annual assessment, which takes a holistic view of health care and social care in England. Due to COVID-19 and its effect on the health and care system, this report takes a slightly different spin from previous years. However, it is important to note the inspection data and ratings cover up to March 2020. As a result, the full impact of COVID-19 on the system will be covered in more detail in next year’s publication.

Key points

Overall, it was found that provider performance and ratings of care were generally good, with 67 per cent of acutes being rated as good and 8 per cent as outstanding. There was an improvement in leadership figures. 

However, the report recognises areas that required a significant amount of work pre-COVID-19, such as mental health, where CQC continued to find worrying levels of care in inpatient wards for people with a learning disability and/or autistic people. The overall proportion of services rated as inadequate rose from 4 per cent to 13 per cent. For urgent and emergency care, more than half of services were rated as requiring improvement. Despite the challenging conditions, it was warming to see that both leaders and frontline staff in the different sectors, including mental health and emergency care, were largely seen to be caring.

Health inequalities is a key theme throughout the report and, similarly to our work with the NHS Reset campaign, it highlights how inequalities existed in the NHS prior to COVID-19, and how the pandemic has exacerbated inequalities between groups and has had a large impact on people from black and minority ethnic (BME) backgrounds, people with disabilities and people living in more deprived areas. 

We welcome the report’s view that tackling health inequalities needs to become an integral part of NHS and social care service delivery. The report also highlights the impact that COVID-19 had in terms of delays to elective and diagnostic care, and urgent services such as cancer and cardiac services, and how this can further aggravate health inequalities. Our members continue to work to restore routine services and prioritise those most in need clinically, but the second surge has the potential to reduce the ability to deliver other services and so, widen existing inequalities. 

As seen in the previous two reports, adult social care remains an area of concern, which requires significant funding imminently as well as joined-up working between the health and care sectors. The report acknowledges that there have been short-term interventions to deal with social care issues but the need for a longer-term funding plan has still not been addressed. This is an issue that we at the NHS Confederation and our members, through the Health for Care campaign, have been vocal about for a number of years. 

The report highlights that the current way of working creates barriers between the health and social care systems. Throughout our NHS Reset campaign, we have been clear on the need to strengthen partnership working. It is known that patients experience the best care when the barriers to collaboration between health and social care system are removed. More needs to be done by the government to allow this to happen.

We welcome the report’s focus on the importance of collaboration and how providers have built strong working relationships during the pandemic. System working and collaboration is a priority for our members, who have highlighted that COVID-19 strengthened partnership working. In line with the intelligence we have received from members, CQC found that there was evidence that the places with established working relationships and an understanding of need in their local areas were better able to care for the local population in a time of crisis. Given this, we are keen to see how an improvement in collaboration and system working has strengthened performance in next year’s report.

To deal with COVID-19 and its effect on the health and care system, there was a transformation in the way care was delivered, from an increase in digital innovation to a change in reporting. With the changes being implemented at pace, naturally there will be some unintended consequences – such as periods of uncertainty for providers, which caused confusion and at times left them feeling overwhelmed. The report also looks at the challenges ahead and the difficulties expected as services restart, with a focus on how to deliver COVID-19-safe services, as well as how to deal with the backlog of work that came as a result of electives being stood down. 

Moving forward, an upcoming challenge will be for the system to keep and develop the successful innovations while making sure that no one is disadvantaged in the process. We are glad that the CQC acknowledged this uniquely challenging environment for providers, which brings to light the need to continue to have more proportionate regulation. 

Our view 

While this report is a useful picture of the healthcare system, we acknowledge that more needs to be done in terms of regulation, especially as COVID-19 has altered the way the system works.  Following our engagement with the CQC to halt regulation during COVID-19, we will continue to work with the regulator to develop a more proportionate approach to regulation. 

From engagement with our members, we are aware that issues such as lack adequate investment in both health and social care, and support for the current and future workforce, has an impact on the quality of care that staff can provide. We will continue to work with members to improve system working and we will continue engaging with government to make health inequalities a focus in the health and care system. We are keen to see an improvement in funding to mental health and social care, as well as support and guidance for providers to meet the targets set. 

As we move into winter, and the second wave, it is vital that systems continue to work together to ensure high-quality of care for the public.

Teju Sogbetun is a senior policy adviser at the NHS Confederation. Follow us on Twitter @NHSConfed