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The state of health care and adult social care in England 2021/22

We understand that staying updated with the latest developments in the healthcare sector is crucial. Below is a summery of a report that The Care Quality Commission (CQC) has published, it looks at the trends, shares examples of good and outstanding care, and highlights where care needs to improve.

The health and social care
system is gridlocked

Twelve months ago, we highlighted the risk of a
tsunami of unmet need across all sectors, with increasing numbers of people
unable to access care. We said that funding must be used to enable new ways of
working that recognise the inter-connectedness of all health and care services,
not just to prop up existing approaches.

Today, our health and care system is in gridlock
and this is clearly having a huge negative impact on people’s experiences of

People in need of urgent care are at increased risk
of harm due to long delays in ambulance response times, waiting in ambulances
outside hospitals and long waiting times for triage in emergency departments.

Large numbers of people are stuck in hospital
longer than they need to be, due to a lack of available social care . And
people’s inability to access primary care services is exacerbating the high
pressure on urgent and emergency care services.

At the heart of these problems are staff shortages
and struggles to recruit and retain staff right across health and care.

One major survey shows the proportion of people
satisfied with the NHS overall dropping from 53% to 36%. More people (41%) were
dissatisfied with the NHS than satisfied. Another survey shows that the
proportion of people who reported a good overall experience of their GP
practice went down from 83% to 72%.

People are struggling to access

The repercussions of the COVID-19 pandemic continue
to be felt by individuals, families and care staff – people are still being
affected by problems ranging from frustrations in accessing regular
appointments to delays that stop people getting the life-saving treatment they
need when they need it.

Many people are still waiting for the health and
social care support and treatment they need, and many are waiting too long.

We commissioned a survey of more than 4,000 people
aged 65 and over who had used health or social care services in the previous 6
months. Over 1 in 5 people (22%) said they were currently on a waiting list for
healthcare services like diagnostic tests, mental health services, consultant
appointments, an operation or a therapeutic service such as physiotherapy.

More than a third (37%) on a health waiting list
did not feel well supported by health and care services . Two in 5 (41%) said
their ability to carry out day-to-day activities had got worse while they were

There is variation across the country in waiting
times for elective care and cancer treatment. People living in the worst
performing areas were more than twice as likely to wait more than 18 weeks for
treatment as people in the best performing areas.

In our community mental health survey 2021, only 2
in 5 respondents felt they had ‘definitely’ seen NHS mental health services
enough for their needs in the last 12 months. This was the lowest score across
the period from 2014 to 2021.

People are also struggling to access GP practices
and NHS dental care. Worryingly, the GP Patient Survey showed that over a third
of people didn’t see or speak to anyone when they couldn’t get an appointment
at their GP practice, and more than 1 in 10 went to A&E. There has also
been a significant reduction in the availability of NHS dental care,
particularly for children and young people.

Around half a million people may be waiting either
for an adult social care assessment, for care or a direct payment to begin, or
for a review of their care. In the first three months of 2022, 2.2 million
hours of homecare could not be delivered because of insufficient workforce
capacity, leading to unmet and under-met needs. At the same time, care home
profit margins are at their lowest level since our Market Oversight scheme
began in 2015.

Inequalities pervade and persist

Inequality continues across large parts of health
and social care. It is vital that everyone, inclusively, has good quality care,
and equal access, experience and outcomes from health and social care services.

Health and social care providers need to do more to
make their services accessible, especially to people with different
communication needs.

Our survey of more than 4,000 older people who had
used health and social care services in the last 6 months found that those
living in the most deprived areas were more likely to report that they had a
long-term condition, disability or illness, compared with those living in less
deprived areas. They also tended to use fewer health services than average,
although they did use them more frequently. We also found that disabled people
were less likely than non-disabled people to describe the care and support they
received for their health and wellbeing over the previous 6 months as good.

Furthermore, disabled people, those with a
long-term health condition and people living in more deprived areas were less
satisfied with being able to access services when they need them and in a way
that suits them.

Wider inequalities issues include our finding that
ethnic minority-led GP practices are more likely to care for populations with
higher levels of socio-economic deprivation and poorer health – this increases
the challenges they have around recruitment and funding.

The recording and use of demographic data by
services generally needs to improve, to make sure data is complete, accurate,
widely shared and used to bring about improvement.

Specific concerns

In 2021/22 we continued to focus on higher risk
providers and where people were most at risk of receiving poor care.

Overall, when people have been able to actually
access the care they need, we have been able to reassure people that the
quality of care at the point of delivery is mostly good. Health and social care
staff across the country are working relentlessly to ensure people are kept
safe . At 31 July 2022:

  • 83% of adult social care services were
    rated as good or outstanding.
  • 96% of GP practices were rated as good or
  • 75% of NHS acute core services were rated
    as good or outstanding.
  • 77% of all mental health core services
    (NHS and independent) were rated as good or outstanding.

But we have deep concerns about some types of care.
The quality of maternity care is not good enough. Action to ensure all women
have access to safe, effective and truly personalised maternity care has not
been sufficiently prioritised to reduce risk and help prevent tragedies from
occurring. Furthermore, women from ethnic minority groups continue to be at
higher risk of dying in pregnancy and childbirth than White women, and more
likely to be re-admitted to hospital after giving birth.

Also, the care for people with a learning
disability and autistic people is still not good enough. Despite multiple
reviews and reports, people continue to face huge inequalities when accessing
and receiving health and social care. Our review of the care in hospital for
people with a learning disability and autistic people will highlight how they
are not being given the quality of care they have a right to expect.

Mental health services are struggling to meet the
needs of children and young people. This increases the risk of their symptoms
worsening and people reaching crisis point – and then being cared for in
unsuitable environments.

Ongoing problems with the Deprivation of Liberty
Safeguards process mean that some people are at risk of being unlawfully
deprived of their liberty without the appropriate legal framework to protect
them or their human rights.

Depleted workforce

Across all health and social care services,
providers are struggling desperately to recruit and retain staff with the right
skills and in the right numbers to meet the increasing needs of people in their
care. Despite their efforts, in many cases providers are losing this battle, as
staff are drawn to industries with higher pay and less stressful conditions.

Sickness, vacancy and turnover rates are having a
deep impact. Continuing understaffing in the NHS poses a serious risk to staff
and patient safety, both for routine and emergency care; and shortages in
social care are even worse than they are in the NHS. Retention of staff is just
as big a challenge as recruitment, one that in many cases is crucial to
maintaining relationships between staff and patients. These relationships can
be lost if there is a high turnover of staff or increased use of agency or bank

More than 9 in 10 NHS leaders have warned of a
social care workforce crisis in their area, which they expect to get worse this
winter. Care homes have found it very difficult to attract and retain
registered nurses. We have seen nurses moving to jobs with better pay and
conditions in the NHS, and care homes that have had to stop providing nursing

In our workforce pressures survey, 36% of care home
providers and 41% of homecare providers said that workforce challenges have had
a negative impact on the service they deliver. Of the providers who reported
workforce pressures having a negative impact, 87% of care home providers and
88% of homecare providers told us they were experiencing recruitment
challenges. Over a quarter of care homes that reported workforce pressures told
us they were actively not admitting any new residents.

Only 43% of NHS staff said they could meet all the
conflicting demands on their time at work. Ambulance staff continue to report
high levels of stress.

Challenges and opportunities in
local systems

This year, integrated care systems (ICSs) were
formally established and the role of integrated care boards set out in
legislation. This will bring with it a new role for CQC to review and assess
each ICS, starting next year.

We have for several years been looking at the
challenges for systems, particularly around inclusivity and planning in health
and care services for residents.

From our own work looking at care within the
emerging and newly formed systems, and from listening to people’s experiences
of care, we can point to some areas of focus for local systems as well as some
tangible collaborations that are already making a difference in people’s lives.
Local partnerships are starting to make a positive difference – they must be
focused on outcomes for people.

Understanding the health and care needs of local
people is paramount for integrated care systems, and each one faces a different
challenge in meeting those needs. Good leadership will be vital for local
systems as they become established during challenging times for all services.
All services working in a local health and social care system should be
included in planning for healthier communities.

To maintain and develop the required workforce, as
well as to plan for the future, providers and systems need to be clear about
demands in the longer term, including the required workforce skillsets. A
strong understanding of local community needs is required to ensure the right
services, including preventative health measures and plans for improving health
outcomes, are delivered.

To read the entire report please click here