Disability charities have called for an end to the ‘scandalous gaps’ in the health and social care system as the latest State of Care report from the Care Quality Commission (CQC) highlights how much the system is buckling under enormous pressure.
The State of Care report, which looks at the quality of care over the past year, found that the cost-of-living crisis and workforce pressures have escalated leading to unfair care.
As local authority budgets have failed to keep pace with rising costs and the increase in the number of people needing care, there is the risk that people who live in more deprived areas who need local authority funded care, may not be able to get the care they need.
The CQC said private providers are also struggling to pay their staff a wage in line with inflation, which affects recruitment and retention as well as quality of care. Data from CQC’s Market Oversight scheme shows that care home profitability remains at historically low levels.
Dr Rhidian Hughes, Chief Executive of the Voluntary Organisations Disability Group (VODG) said that the latest assessment from the State of Care report will come as no surprise to the millions of disabled people who use care and support services across the country.
She added: “As CQC paints a picture of ‘unfair care’ there is no doubt that the country’s social care lottery is just that as local authorities juggle funding priorities and make decisions that can adversely impact people’s independence. As hours of support are cut we are witnessing rising levels of unmet need amongst disabled people, and the widening disparities in health inequalities are reflective of the continued erosion of essential prevention services.
“Successive governments have failed to harness the potential and address the challenges of social care and with it have failed disabled people and their families. As we approach a general election next year, we are calling on all political parties to choose to make a difference and invest in the financial resources, commissioning approaches and collaboration with the third sector, that would put care and support back on track.”
The report also found that the number of people on waiting lists for treatment has grown to record figures and in the face of longer waits, those who can afford it are increasingly turning to private healthcare.
It said that research by YouGov shows that eight in 10 of those who used private health care last year would previously have used the NHS, with separate research showing that 56% of people had tried to use the NHS before using private healthcare.
This situation is likely to exacerbate existing heath inequalities and increase the risk of a two-tier system of health care, with people who cannot afford to pay waiting longer for care. CQC’s adult inpatient survey, based on feedback from over 63,000 people, found that 41% felt their health deteriorated while they were on a waiting list to be admitted to hospital.
The King’s Fund said that history has shown us that a slow slide towards a two-tier health service can be avoided through a concerted effort to bring down NHS waiting lists, led and funded by government.
Sally Warren, Director of Policy at The King’s Fund, added: “Public satisfaction with the NHS is at a record low. Despite this, and despite signs that some people are paying for care out of their own pocket while others simply go without, public support for the founding principle of services being free at the point of use remains rock solid.
“The report also highlights key areas where leaders across the NHS need to take action to ensure an equitable, fair and compassionate culture across their local teams, organisations and systems. Examples stretching from racial stereotypes in maternity care, or inappropriately restraining patients in mental health settings, shows that leaders have work to do to create a culture focused on ensuring teams are enabled to treat all patients with care, compassion, dignity and fairness.”
“All systems need clear and realistic goals – and support to achieve these – that reflect how they will address unwarranted variations in population health and disparities in access, outcomes, and experience of health and social care.
“This opportunity must be grasped to ensure fairer care for everyone – so people get the care they need, not just the care they can afford.”
Ian Dilks, Chair of CQC
The State of Care report found that access to and quality of mental health care also remain a key area of concern. Gaps in community care continue to put pressure on mental health inpatient services, with many inpatient services struggling to provide a bed, which in turn leads to people being cared for in inappropriate environments – often in A&E.
One acute trust reported that there had been 42 mental health patients waiting for over 36 hours in their emergency department in one month alone. When people do get a bed in a mental health hospital, the quality of care is often not good enough. Safety continues to be an area of concern, with 40% of providers rated as requires improvement or inadequate for safety.
Recruitment and retention of staff also remains one of the biggest challenges for the mental health sector, with the use of bank and agency staff remaining high and almost one in five mental health nursing posts vacant. CQC has raised concerns that staffing issues in mental health services are leading to the over-use of restrictive practices, including restraint, seclusion, and segregation, and called on providers to recognise and take steps to address this.
The National Autistic Society said that the State of Care report was yet more evidence of a situation that is beyond worrying. In its starkest terms yet, the Care Quality Commission has set out how the health and social care systems continue to buckle under enormous pressure, made worse by the cost of living crisis and record staff vacancies.
Tim Nicholls, Head of Influencing and Research at the National Autistic Society, added: “Autistic people aren’t getting the right support and as a result too many are stuck in inappropriate hospital settings where they are at risk of being pinned down, overmedicated and isolated. This is a human rights scandal for autistic people and it cannot be allowed to continue.
“Government must include the Mental Health Bill in the upcoming King’s Speech to urgently reform outdated mental health law so that autistic people get support in their homes and communities, with their families around them. As well as that, government needs to keep its commitments in the autism strategy, which depend on both health and social care being there for autistic people when they need them.
“This report is crystal clear about the scandalous gaps in support for autistic people. The government must invest to close those gaps and create a health and social care system that actually works for autistic people.”
