State of Care, the CQC’s annual assessment of health care and social care in England.

Friday, October 16, 2020

The CQC’s annual report, State of Care was published today, it’s the CQC’s annual assessment of health care and social care in England. The report looks at trends, shares examples of good and outstanding care, and highlights where care needs to improve.

This year they have looked at the quality of care before the pandemic, the impact of the coronavirus, collaboration between providers and looking forward, the challenges and opportunities ahead.

You can read the full report here however for Social Care the key points are:

The quality of care before the pandemic

The care that people receive in England is mostly of good quality. As of 31 March 2020, 80% of adult social care services were rated good and 5% as outstanding. (31st July 2019 the figures were 80% and 5% respectively. Although providers were able to maintain the quality of care provided, there has been no large improvement overall.

There has been a greater willingness among services to work together, with a shift in providers’ mind set from being competitive to being more collaborative – acknowledging the benefits and need to work with others to provide joined-up person-centred care and to ensure the specific needs of communities are met. However the CQC noted that there is a wide variation in collaborative working in all regions, and within local areas.

Adult social care remains very fragile. The CQC have been calling for a better funding settlement for adult social care for years and last year they warned this was having a damaging impact on the quality and quantity of available care. The CQC believe that the failure to find a consensus for a future funding model continues to drive instability in this sector, and are urging Parliament and government to make this a priorty. Analysis from the Competition and Markets Authority’s market study into residential and nursing care homes for older people found that the current model of service provision cannot be sustained without additional public funding. 25% of care homes have 75% of their residents funded by local authorities and these are the homes that are most at risk of going out of business as many care homes rely on self-funders which pay higher prices to remain viable.

There are difficulties across the country for people trying to access residential care with nursing which is linked to the challenge of recruitment of nurses. There is also a lack of suitable provision for people with high support needs, including people living with dementia.

Staffing issues in all regions have been a key factor affecting access to services. Inspectors and external stakeholders have heard about services competing for staff, with smaller services and those in rural or deprived areas facing particular challenges filling vacancies.

The most recent data from Skills for Care shows how turnover rates for care workers and senior care workers have risen steadily over many years. Care workers staff turnover has gone from 32% in 2014 to 39% last year.  

A fundamental change is needed for people with a learning disability and autistic people who need complex care. The report makes it clear that for people in segregation creating a package of care to meet their individual needs was often seen as too difficult to get right and they had fallen through the gaps.


The Impact of Coronavirus

Key points

As the pandemic gathered pace, health and care staff across all roles and services showed resilience under unprecedented pressures and adapted quickly to work in different ways to keep people safe.

In hospitals and care homes, staff worked long hours in difficult circumstances to care for people who were very sick with COVID-19 and, despite their efforts to protect people, tragically they saw many of those they cared for die. Some staff also had to deal with the loss of colleagues to COVID.

A key challenge for providers has been maintaining a safe environment – managing the need to socially distance or isolate people due to COVID-19. Good infection prevention and control practice has been vital.

The CQC thinks it is important that the learning and innovation that has been seen during the pandemic is used to develop health and social care for the future. New approaches to care, developed in response to the pandemic and shown to have potential, must be fully evaluated before they become established practice.


Collaboration between providers

In July and August 2020, the CQC mobilised teams to carry out provider collaboration reviews in 11 different English localities, to find out how providers had worked together in the face of the pandemic. They hope the reviews will be used to inform planning for this autumn and winter with the resurgence of COVID-19.

The reviews focused on care for people aged over 65 – the age group most impacted by COVID-19.

Key points

The success of collaboration between providers to keep people safe was varied, often affected by the maturity of pre-existing relationships within the system.

Understanding the needs of local populations including cultural differences, was especially important.

Sectors did not feel consistently engaged in the coordination of responses to the crisis.

Health and social care staff worked above and beyond, with a shared drive to look after people well and keep them safe.

System areas benefitted from the pace of effort to secure a regional level grip across communication, support and joint working approaches, in response to confusion from the pace of national guidance.

The voluntary sector played a critical role in supporting health and social care to keep people safe. System-wide leaders were concerned about capacity to meet the demands of subsequent peaks without this support.

Well planned governance, clear decision-making arrangements and escalation plans,  were where the system-wide responses were most effective.

Areas with sector and pathway oversight cells secured increased communication, timely information sharing and collective partnership decisions.

Higher levels if confusion and duplication of effort were found when governance arrangements were unclear.

The engagement of all sectors to system level responses varied. Where there was less engagement, there was a disconnect between communication and information within and across providers.


Looking forward

Key points

The problems that existed before COVID-19 have not gone away.

The fact that the impact of COVID has been felt more severely by those who were already likely to have poorer health outcomes makes the need for services to be designed around people’s needs all the more critical.

There needs to be a new deal for the adult social care workforce that reaches across health and care – one that develops clear career progression, secures the right skills for the sector, better recognises and values staff, invests in their training and supports appropriate professionalisation.

Primary care services need to make sure that people and patients are given the confidence to interact with them early, provide a range of ways for people to access the care they need, and to make it easy for them to do so.

The increased waiting lists and backlog of urgent and elective care need to be addressed – services need to assess and prioritise patients so that they are treated according to clinical need and that people waiting for long periods for treatment are kept safe.

We must use the learning from the pandemic to lock in positive changes, and drive a new way of working that is supported at a national, regional and local level by the whole health and care system.


In response to the State of Care report, Professor Martin Green, Chief Executive of Care England, said: “Although this year’s State of Care report makes a raft of important recommendations including a new deal for the adult social care workforce, it is disappointing to note that the report is predominantly a narrative of events which spanned the Covid-19 pandemic, as opposed to a critical reflection of what must change. This is underscored by the lack of internal reflection from CQC as to its handling of the crisis.”