Care Quality Commission The State of Health Care and Adult Social Care 2016/17 Member briefing and NHS Confederation viewpoint 10 October 2017

NHS Confederation viewpoint This report shows that the quality of services is in a fragile state as the system strains to support more older people with complex conditions.  The health and care system is managing well, with some improvements in safety, but its future is precarious. The herculean effort of leaders and staff have delivered safe services to millions, but the pressures are taking their toll.

NHS Confederation viewpoint There are huge efforts going into improving the coordination of local services, but much still to do. Further reform of how care is delivered is essential but without further funding, the ‘precarious’ state described by CQC, more services will not cope. That’s why we believe the whole political class needs to wake up to the challenge of delivering sustainable health and social care.

Introduction The CQC produces an annual report on the state of health and care in England. It is based on their inspections and ratings of services from across health and care. In 2016 they stated that adult social care was ‘approaching a tipping point’ where deterioration in quality would outpace improvement.

Context The complexity of demand continues to rise with growing acute admissions, ambulance calls and increasing demand for community and mental health services, adult social care and primary care. The ability of services to meet this demand is being pushed to the limits – shown through rising admissions, high bed occupancy and struggles to meet targets such as the four-hour A&E limit.

Quality The quality of care overall is good and improving: Adult social care – 78% good Acute hospital core services – 55% good NHS mental health core services – 68% good GP practices – 89% good Lower rated trusts that were inspected again have tended to improve their ratings But some services originally rated good have since deteriorated.

CQC messages on joined-up, person- centred care Providers need to think beyond organisational boundaries to provide joined-up, person centred care – CQC says this needs to happen with “more consistency and urgency” and national leaders need to support it. There is too much variation in progress towards the aims of the Five Year Forward View. Integrated care needs to be based on trusting relationships and a shared common goal.

Adult social care 80% of services were rated good or outstanding. Caring was the highest rated key question. Inadequate ratings were usually linked to governance, safety, staffing and person-centred care. One year on from social care being at “a tipping point” CQC says the situation is still precarious. The report says a long-term sustainable solution to funding social care must be found.

NHS secondary care 61% of acute core services were rated good or outstanding. Four of the ten ambulance services were good or outstanding. 72% of community health services were good or outstanding. 71% of independent acute hospitals were good or outstanding.

Mental health 74% of core NHS services were good or outstanding. 75% of independent providers were good or outstanding. The vast majority of staff are considered caring and compassionate but there are issues around safety.

Primary care GP practices have the highest ratings – 93% good or outstanding. There are concerns about workforce, with numbers of GPs not increasing in line with populations.

Find out more Download the report from the Care Quality Commission website. For further information, please contact Eleanor Pearce-Willis, senior policy officer, at Eleanor.Pearce-Willis@nhsconfed.org Follow us on Twitter @nhsconfed