The CQC's State of Care report for 2017 reveals that the quality of the UK's health and social care has been maintained despite some very real challenges and largely through the efforts of the staff working within the system. However, it cautions that staff resilience is not inexhaustible and that in areas the quality of care has started to deteriorate.
The healthcare needs of the population are becoming more complex, with people living longer and with chronic or multiple conditions; more children and young people are being diagnosed with mental health problems; bed occupancy is higher than ever; ambulance calls are increasing and the number of patients attending A&E departments is also on the up.
"Quality has improved overall, but there is too much variation and some services have deteriorated," says the report, which recommends a continued, collaborative approach between health and social care professionals and organisations, patients and the public to shape services for the future. Furthermore, where care is fragmented, it is built around the priorities or targets of the services rather than the needs of the people. "To deliver good, safe, well co-ordinated care that is sustainable into the future, providers will have to think beyond their traditional boundaries and reflect the experience of the people they support."
The report has drawn comment from several organisations.
From the Health Foundation, Ruth Thorlby, Assistant Director of Policy, says: "We welcome this report’s findings that, broadly speaking, the quality of health care is holding up. This achievement is testament to the hard work of NHS and social care professionals, who are working under immense pressures. However, the report highlights areas of concern, particularly that waiting times have increased for vulnerable people - older people, as well as children and young people with mental health problems.
"We need an integrated, national approach to health and social care to address the concerns the report raises, to achieve better health and health care for everyone. The good will and hard work of the NHS’s workforce will not alone solve the problems in the wider system, that are resulting in poor care.
"The additional £2bn made available by the Chancellor in the Spring budget was a welcome acknowledgement of the pressure the adult social care sector is under. What is now required is a long-term sustainable solution for the future funding and quality of adult social care. As a start, clarity from government on what progress is being made would be helpful."
Richard Murray, Director of Policy for The King’s Fund, says: "This report highlights once again that the NHS is under increasing pressure, with demand for services growing faster than funding and with recruiting and retaining staff representing a huge challenge. But while patients are having to wait longer to access care in some cases, it is encouraging that the majority of care that people receive is still good quality. The credit for this goes to the NHS staff whose hard work and commitment often act as shock absorbers in the system, but to expect staff to continue to work harder is clearly not a sustainable strategy.
"The report also shows the continued instability in the social care sector, with wide regional variation in performance and falling capacity despite increasing demand. We agree that social care is one of the unsolved policy issues of our time, and the forthcoming consultation on social care needs to set out costed options for putting social care on a sustainable footing for the future. It is vital that the government fulfils its manifesto commitment to act ‘where others have failed to lead’ and that other parties approach this in the spirit of cross-party consensus that will be needed to affect real and long-lasting change.
"This will mean confronting hard choices about how to pay for this through a combination of private and public funding. As well as increases in tax and National Insurance, this will involve looking at other options such as redirecting public spending, for example on winter fuel payments and perhaps Attendance Allowance, and being explicit about the role of housing wealth."
Nuffield Trust Director of Research Professor, John Appleby says: “This report shows that although most NHS patients still receive good and safe care, the system as a whole is struggling to cope. The CQC’s warnings must be seen in the context of the unsustainable financial squeeze. The NHS ended last year with an underlying deficit of £3.7bn and faces an even greater challenge this year.
“If the response to this problem is to try to exert more grip and push harder from Whitehall, it will fail: at this stage staff and leaders can’t work much harder. We need supportive leadership which puts the emphasis on working together to tackle difficult changes.
“Perhaps the most worrying parts of this report touch on social care for older people. One in eight are not receiving the care that they need in the community, and costs have already been pushed so low that companies are giving up contracts. We agree that the future funding and organisation of social care is becoming one of the greatest unresolved policy issues of our time, and action on this is now an important priority.”
