Report: The state of health care and adult social care in England 2020/21 – Care Quality Commission

Last year’s State of Care was written as the country fearfully anticipated a second wave of COVID-19 infections and deaths.

This year, the success of the vaccination programme has given hope that the virus can be contained – but alongside this hope is the recognition that COVID-19 will continue to cast a long shadow over all aspects of everyday life, in particular the health and care system.

The system has not collapsed – but the system is composed of individuals, both those who deliver and receive care, and the toll taken on many of these individuals has been heavy. As we approach winter, the workforce who face the challenges ahead are exhausted and depleted, which has implications for the quality of care. They cannot work any harder – they need support to work differently.

The impact on people who use health and social care services has been damaging: the man whose lung cancer went undiagnosed; the teenage girl whose mental health support was paused; the boy with a learning disability whose mother, also his advocate, wasn’t allowed to visit him; the woman who contracted COVID-19 in late pregnancy.

Many of the underlying problems are not new – access to children and young people’s mental health services, concerns about closed cultures in services for people with a learning disability or autistic people, and poorer experience and outcomes around childbirth for Black and minority ethic women are all issues that pre-date COVID. But as we flagged last year, COVID-19 has exacerbated inequalities and continues to do so, meaning that people who were less likely to receive good care before and during the pandemic are in many cases the same groups disproportionally impacted by COVID-19.

People with a learning disability, for example, are significantly more at risk from COVID-19 – but our review of community care for people with a learning disability found that their physical health, including how COVID-19 may present, was not always considered. Our inspections of services for people with a learning disability or autistic people continue to find examples of care so poor that we need to take action to keep people safe.

To help address the multiple challenges faced by the care system, the government has now made a welcome £5.4 billion investment – it must be used to enable new ways of working that recognise the interdependency of all care settings, not just to prop up siloed approaches and plug demand in acute care. The £500 million committed to support the adult social care workforce has never been needed more, with rising vacancy rates as social care providers struggle to attract and retain staff. Monthly data from information submitted to CQC by providers of residential care shows their staff vacancy rate increasing steadily from 6.0% in April 2021 to 10.2% in September 2021. Some care homes whose attempts at recruitment have failed are now having to cancel their registration to provide nursing care, leaving residents looking for new homes in local areas that are already at, or close to, capacity.

If the funding for social care is to have any impact, there must be a sharp focus on developing a clearly defined career pathway for social care staff – linked to training and supported by consistent investment, higher overall levels of pay to increase the competitiveness of the market, and good terms and conditions to ensure employers can attract and retain the right people…

Click here to download the full report.