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Health and social care system at full stretch

10 October 2017

Health and social care system at full stretch

Health and social care is struggling to meet the increasingly complex needs of the population, this year’s State of Care report, published by the CQC has today warned.

As published in the National Health Executive online, the report, based on inspections of almost 29,000 services, shows that 78% of adult social care services and 55% of acute NHS hospitals are rated as good.

It also reveals that 68% of NHS mental health core services and 89% of GP practices have made improvements following CQC inspections to improve their ratings.

However, despite some positive findings, the CQC has warned of the changing nature of the demand upon health and social care services, with increasing numbers of older people, many with dementia, and more people living with long-term complex conditions placing “unprecedented pressure” on the system.

This means longer waits in A&E, cancelled operations, and people waiting longer for treatment. In adult social care, the number of beds in nursing homes has decreased across most of England and domiciliary care contracts are being handed back to councils due to insufficient funding.

Chief executive of the CQC, Sir David Behan, praised those delivering care in difficult conditions. He said: “The fact that the quality of care has been maintained in the toughest climate that most can remember is a testament to the efforts of frontline staff, managers and leaders.

“Many providers have used our inspection reports to improve, and we have seen improvements in safety in particular, although this area remains a big concern and focus for us.

“However, as people’s health and care needs change and become more complex, a model of care designed for the 20th century is at full stretch and struggling to cope with 21st-century problems.”

Niall Dickinson, chief executive of the NHS Confederation, has responded to the report. Although he tentatively praised the NHS’s achievements, he expressed concerns: “Let no-one misunderstand what is being said here - the health and care system is managing well, with some improvements in safety, but its future is precarious. And one in eight older people are not getting the help they need.

“CQC has the support and confidence of government, yet this message is not a comforting one - once again with herculean effort, leaders and those on the front line have delivered safe services to millions but the pressures are taking their toll.”

The chief executive of the Mental Health Network, Sean Duggan added: “The challenges faced by the sector are well-known, but we would add that the system continues to function well despite these pressures.

“The Five Year Forward View for Mental Health identified the need for additional investment and it’s imperative that we stick to this plan. Funding must reach the frontline, particularly in priority areas such as crisis response and child and adolescent services.”

Dr. Liam Brennan, president of the Royal College of Anaesthetists (RCoA), addressed the cost that problems with social care can add to the NHS: “The proportion of delayed patient transfers which are attributable to issues with social care - rather than NHS services - have increased from less than one-quarter to nearly four in ten in just a three year period.

“This is contributing to the frequent cancellation of elective surgery that is distressing and potentially harmful for patients. 

“As many as 8,500 beds in acute trusts are occupied by a patient who is medically fit to be transferred and the cost of these delays to the NHS is estimated to be between £900m to £1.2bn per year.”

He continued: “However, the report also recognises that the future of quality and safety within the system is precarious and that issues of staff recruitment, retention and welfare abound.

“Results from RCoA surveys of its membership shows that 85% of anaesthetists in training are at risk of becoming ‘burned-out’ and that one-third of anaesthetists are struggling to deliver effective patient care, citing issues such as low morale, high levels of fatigue, a lack of qualified staff and inadequate facilities.

"We need to address these issues to ensure a healthy sustainable workforce, able to adequately care for its patients.”

Commenting on the way in which the needs of service users have changed, Andrew McCracken from National Voices, the coalition of 160 health and care charities, said: “The way services provide care is outdated and often fails people with long-term conditions, despite the fact they account for 70% of NHS spending.

“Our own analysis shows that only 3% of GP patients with a long-term condition said they had a care plan.

“People’s needs don’t neatly fall into organisational boxes and services must be better coordinated.”

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