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Fragile adult social care sector 'at tipping point' despite good care says watchdog

Article By: Angeline Albert, News Editor

The majority of care homes and home care providers are giving ‘good quality care’, the Care Quality Commission (CQC)’s State of Care report reveals but growing demand and financial pressures mean the adult social care market is ‘approaching a tipping point.’

‘Closures and undeliverable contracts'

Care providers are being forced to shut settings and turn down care contracts from local authorities, despite the fact many give good care and three quarters of 'Inadequate’ care providers improved when they were re-inspected.

As of 31 July 2016, 71 per cent of the adult social care services that the care watchdog had inspected were rated Good.

In the regulator’s report, published on 13 October, it states: 'Large numbers of care homes and home care agencies are providing good quality care – and three-quarters of those that we had rated as inadequate, and then re-inspected, improved.'

Financial woes

But the report warns: 'Profit margins are reducing – both due to pressures on fees, and cost pressures that include the national living wage. Already we are seeing some providers starting to hand back home care contracts as undeliverable; local authorities predict more to come.'

The number of older people receiving local authority-funded social care fell 26 per cent from more than 1.1m in 2009 to around 850,000 in 2013/14. Some 81 per cent of local authorities have reduced their real-term spending on social care for older people over the last five years.

The report highlighted the case of Mears Group having served notice to Liverpool City and Wirral councils for offering hourly rates of £13.10 and £12.92 respectively, compared with the minimum of £16.70 recommended by the UK Homecare Association. The CQC stated: ‘They said this would “lead to unworkable pay and conditions for care workers” and “the people who will suffer the most are those receiving care.”

Potential rise in unpaid care

The regulator said that with smaller providers being more susceptible to closures ‘we are concerned that reduced capacity limits people’s choices and ‘may force local authorities to use poorly performing providers.’

The CQC believes the potential impact of care providers exiting the market would be people having less choice, a lack of continuity of service, delays in getting a package of good care and a rise in the use of unpaid care.

Nursing home bed growth stalls

Until recently, the growth in demand for care for people with greater care needs had been met by a rise in the number of nursing home beds, but this bed growth has stalled since April 2015. CQC data shows that a five-year period of steady increase in nursing home beds (up from 205,000 beds in 2009 to 224,000 beds in March 2015) has since remained static.

Care home managers, academics, clinicians and frontline care staff gathered at the Care & Dementia Show in Birmingham on 11-12 October, where the subject of sector underfunding and the mounting pressures on care providers was echoed in the pained conversations people had.

Staffing struggles

While positive innovations are taking place at Good and Outstanding homes, recruitment and retention challenges, highlighted by the CQC's report, were issues felt by two nurses who have collectively spent 35 years working in nursing homes.

Speaking to, one nurse attending the event who did not wish to be named, said: “We just can’t get the staff. We’re finding it hard to recruit the nurses we need to come out to our nursing home. It's the same story for the other homes in the group. I don’t know what the solution is”.

David Behan, chief executive of the CQC said: “We are becoming concerned about the fragility of the adult social care market. The combination of a growing, ageing population, more people with long-term conditions and a challenging financial climate means increased need but reduced access. The result is that some people are not getting the help they need - which in turn creates problems in other parts of the health and care system, such as overstretched A&E departments or delays in people leaving hospital."

Delayed discharges

The CQC report, based on inspections, ratings data and feedback from those needing care, also highlighted that in 2015/16 there was an increase in the number of people forced to wait to be discharged from hospital.

The report stated: “The difficulties in adult social care are already affecting hospitals. Bed occupancy rates exceeded 91 per cent in January to March 2016, the highest quarterly rate for at least six years. And in 2015/16, we saw an increase in the number of people having to wait to be discharged from hospital, in part due to a lack of suitable care options.”

Greater collaboration needed

Mr Behan added: “While there are no easy answers or quick fixes, what distinguishes many of the good and outstanding services is the way they work with others – hospitals working with GPs; GPs working with social care and all providers working with people who use services. Unless the health and social care system finds a better way to work together, I have no doubt that next year there will be more people whose needs aren’t meet, less improvement and more deterioration.”

In the report entitled: ‘The state of health care and adult social care in England 2015/16’ the CQC has made a number of recommendations for integrated care for older people.

• It stressed care plans should be streamlined and information shared across services.

• Ensure older people are fully involved in their care.

• Organisational barriers should be broken down to enable services to intervene early when people are at risk of unplanned hospital admissions.

• Data for integrated care should be developed.

Chris Ham, chief executive of The King’s Fund, said: “The fact that the CQC now believes the social care market is approaching a tipping point adds to the overwhelming evidence that the market is unsustainable in its current form.

“While this is most visible in acute services, it is also important to highlight the huge pressure on district nursing services, where unmanageable caseloads and shortages of staff risk compromising quality of care.

“It is essential that health and social care organisations work together in a more coordinated way. The new models of care and place-based approaches to planning care now being developed across the country are key to this."

Martin Green, the chief executive of Care England,added: "I am proud to say that CQC’s State of Care report shows that, at a time of unprecedented financial constraints and rising need for care, 71 per cent of the adult social care services inspected were rated ‘good’.

"Despite the excellent work of social care workers and managers, underfunding is damaging the sector. Care England members are still being asked to care for adults with complex needs for as little as £2.25 per hour."

Caroline Abrahams, charity director for Age UK, was among those calling for more social care funding in the Autumn Statement. She said: "Because of lack of money and the drip drip closure of care providers it is becoming ever harder to find good, affordable care.

“Next month's Autumn Statement is an opportunity for the Government to give social care the priority it deserves in terms of public spending and this report shows how important it is that the Government acts. Otherwise 'a tipping point' threatens to become something infinitely worse, placing many older people at risk of harm.”


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Tom Cooper

Tom Cooper

09 Nov 2016 12:38 PM

This is simply a question of money. Care providers have made massive financial investments in their services and operate in a ludicrously over-regulated environment that presents huge risk, including serious potential criminal liability. Now, due to progressive reductions in the fees they are paid by local authorities since 2008, while simultaneously being forced to comply with ever tighter regulations enforced by the blinkered inspectors of the Care Quality Commission and local authority so-called "quality improvement" officers, as well as absorbing the National Living Wage and auto-enrolment pension schemes, they cannot realise a decent return on their investments. Why would any sane business person persevere with so dire a risk/reward ratio?

CQC may have belatedly - after nearly a decade - noticed the effects of the problem but has failed to recognise that it is part of the problem itself by forcing very expensive "improvements" on providers, irresponsibly using the threat of cancellation of registration in respect of shortcomings found at inspections, most of which are minor matters that are reported in a wholly unbalanced and exaggerated way designed to present the care provider as dangerous and thereby create the impression that CQC is both effective and much needed as a regulator. That is abusive of care home residents as it effectively threatens them with eviction from their homes regardless of their wishes and surely indicates that CQC's motives are largely political i.e. its leaders want to preserve their risk-free berths on the public purse funded gravy train.

Irrespective of CQC however the blunt truth is that as there is virtually no public sector care provision left since the councils sold off all their homes years ago the system must return to allowing providers viable profitability to counterbalance the enormous risks, or they will simply leave the field. Given the massive numbers of elderly people who will enter the care system over the next 25 years as the baby boomers reach their dotage this is the unavoidable reality as they will have to live somewhere and not many organisations will be volunteering to provide care for nothing. Accordingly, whoever is in charge of the money our government raises from the people in tax will eventually be forced to allocate more of the pie to local authorities to spend on social care. It does seem to be taking a very long time for the penny to drop but it will. Maybe now that we have a more mature prime minister as opposed to the complacent forty somethings who have dominated British politics since Thatcher and have wilfully ignored the needs of old people as this totally predictable crisis has grown and grown over the past twenty years the money will be found. Perhaps we should cancel a few vanity projects like HS2 and the absurd refurbishment of the Palace of Westminster and concentrate a bit more on creating the infrastructure to care properly for our elderly over the coming years.

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Dreamer Ken

08 Nov 2016 4:27 PM

If the Autumn Statement ignores care homes finances expect a pretty harsh winter of healthcare implosion. This is way beyond the joke and we have got here through an extraordinary attitude that exists in the public sector that seems hell bent on giving the private sector operators a damned good kicking while they are lying helpless in the gutter. These people are the biggest abusers of older people and the care sector by miles. Maybe now the incompetent leader George Osborne has been ousted there may be a fresh approach, but don't hold your breath.