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The Care Quality Commission’s (CQC’s) annual assessment of the state of health and social care in England has been published and looks at the quality of care over the past year.

This year’s report recognises that while the COVID-19 vaccination programme has given hope that the virus can be contained, it will cast a shadow over all aspects of life long into the future, particularly the health and care system. It says that the pandemic has taken a heavy toll on those who deliver and receive care. With winter approaching, CQC states that the social care workforce will face challenges and are drained in terms of both resilience and capacity, which has the potential to impact on the quality of care they deliver.

The adult social care sector is particularly facing staffing pressures, according to the report. Data from information submitted to CQC by providers of residential care shows the vacancy rate rising month-on-month from six percent in April 2021 to 10.2 percent in September 2021.

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The UK Government has made a £5.4 billion investment to help address the challenges faced by social care. CQC suggests that this money needs to be used to enable new ways of working that recognise the interdependency of all health and care settings, not just to prop up existing approaches and to plug demand in acute care.

£500 million has also been committed to support the adult social care workforce, which is urgently needed for improvements on training, career development and terms and conditions in order to attract and retain staff. Work needs to begin now in order to address the immediate problem of rising vacancy rates as well as planning for the future, the regulator stresses.

In addition, the government has confirmed £16.25 million ringfenced funding for councils to bolster the adult social care workforce and facilitate high-quality care.

Ian Trenholm, Chief Executive of CQC, said: “This year, more people than ever have contacted us with feedback and concerns about care. And as we go into winter, the health and care workforce are exhausted and depleted – which has clear implications for the vital care they deliver.

“While staffing is an issue for all sectors, we’re particularly concerned about adult social care. We’re seeing rising vacancy rates, some providers having to hand back their registrations as they don’t have enough staff to deliver care, and examples of quality suffering due to lack of staff.

“If the new Government funding is to have an impact, it needs to be used to do things differently and to develop genuinely collaborative ways of working across all care settings. And staff need to be supported and rewarded. In order to attract and retain the right people to work in adult social care, there must be a sharp focus on developing a clearly defined career pathway – linked to training, supported by consistent investment, and better terms and conditions and pay.”

Increased stability in social care is the key to unlocking not only improved access and quality of care for the people who use it, but to easing pressure on the NHS by reducing emergency attendances and enabling people to leave hospital in a timely way, CQC emphasises.

There is short-term funding currently in place to help discharge patients who are no longer in need of hospital care but who may still require care services. This has allowed the NHS to treat more patients and has made a crucial difference to the viability of some social care providers.

If this funding were to be committed to for a longer period, care providers could begin to make longer term investments in staffing to provide much-needed step-down care, the regulator underlines. They could also build more meaningful relationships with primary, secondary and community care services – as well with third sector organisations and with carers.

There is also a need for additional funding to be made available now, rather than next year, to areas that will otherwise struggle to meet people’s needs over the coming winter.

Ian continued: “We’re also highlighting the need for an extension to the Discharge to Assess funding in order to capitalise on the benefits it has delivered so far – as well as the need for additional targeted funding immediately to help areas that are struggling get through winter.

“Increased stability on funding and a clear workforce plan for social care benefits everyone – but further instability could result in a ripple effect across the wider health and care system which risks becoming a tsunami of unmet need across all sectors, with increasing numbers of people unable to access care.”

As the number of people seeking emergency care continues to rise, leading to unacceptable waiting times for ambulances and in emergency departments, measures that improve capacity and patient flow are urgently needed, CQC warns. Close working between providers, commissioners and all other parts of the health and care system will be essential to safely manage risk through the forthcoming winter.

Ultimately however, new models of care are necessary to ensure that people receive the care they need where and when they need it, CQC urges. This would mean people are less likely to be inappropriately funnelled into emergency departments – and that primary care services are able to focus on those with complex co-morbidities, rather than patients who could be better treated in other settings and by other allied health professionals. And as waiting lists for investigations and treatment lengthen, ensuring that they are managed well, fairly, and safely will be vital.

In the longer term, the role of Integrated Care Systems (ICSs) will be to ensure that all parts of the health and care system work better together to respond to the needs of their local community – a transformation that may require fundamental changes to funding, oversight, and commissioning, CQC predicts. Designing services around local need must be the priority, ensuring people get the right treatment in the right place at the right time, with good, safe care delivered by a workforce who are valued and supported.

The Care Quality Commission (CQC) is the independent regulator of health and social care in England. It monitors, inspects and regulates services to make sure they meet fundamental standards of quality and safety.

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