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Services are at full stretch and struggling to maintain
standards
The CQC’s headline finding is that most services are good and many providers
have improved the quality and safety of care since inspections. Behind this
headline lies a much more nuanced assessment, with variations between and within
services and evidence of growing pressures on staff and deterioration of quality
in some services. Adult social care is identified as a particular concern, with
a reduction in nursing home beds, providers of domiciliary care handing back
contracts to dozens of local authorities, and an estimated 48 per cent increase
in the number of older people not receiving the help they need since 2010.
The CQC argues that health and care services are working at full stretch and
that staff resilience is not inexhaustible. It is hard to escape the conclusion
that standards in many services are likely to fall in future as a result of
continuing financial pressures. Support for this view can be found in evidence
by Simon Stevens, chief executive of NHS England, to the House of Commons Health
Committee on the day the report was published. Stevens warned that low levels of
funding growth for the NHS in the next two years would result in deteriorations
in care, a reminder if one were needed of the dangers that lie ahead.
Challenges for NHS, government, and CQC
The challenge for the NHS arising from CQC’s assessment is to learn lessons from
the experience of NHS trusts that are performing well even in the face of
financial and operational pressures. According to the CQC, the characteristics
of acute hospital trusts that have improved care include strong leadership,
engaged staff, cultures that empower staff to improve care, a shared vision, and
an outward looking approach. There is more work to do to embed these
characteristics in all NHS providers to ensure that patients receive the best
possible care.
The challenge for the government is to find a sustainable solution for the
future funding of adult social care, described by the CQC as 'one of the
greatest unresolved public policy issues of our time.' The promised green paper
on adult social care provides an opportunity to tackle this problem if the will
exists within the government to examine all the options and to move beyond the
sticking plaster solutions like the Better Care Fund that have so far failed to
deliver. A good starting point is the report of the Barker Commission, which
laid out the hard choices on tax and spending that need to be confronted in
securing sustainable funding for the future.
The challenge for CQC is to use the intelligence and understanding it has
acquired to support improvements in care and not just to hold up a mirror to how
services perform now. It also has more work to do to assess the performance of
local systems of care as well as the organisations providing care. Its
observation that high quality care is delivered when services are joined up
around the needs of people reinforces the importance of work to integrate care
through implementing the NHS five year forward and sustainability and
transformation plans.
Continuing to give priority to the development of these new care models will not
be easy when so much management and clinical time is focused on reducing
financial deficits and meeting waiting time targets. The CQC’s warnings about
the perilous state of some services could have the unintended effect of
strengthening the focus on these operational matters at the expense of work to
transform care. Securing the future of health and social care depends on doing
things differently, not doing more of the same a bit better, and leaders at all
levels have a responsibility to make sure this happens. This must include
providing additional funding to sustain services while options for the longer
term are explored in work on the green paper.