Only two in five people can leave hospital when they are ready, according to CQC report

A lack of available social care is continuing to keep patients in hospital for longer than necessary, according to a new report that shines a spotlight on England’s health and social care sector.

The Care Quality Commission (CQC) has published its annual in-depth assessment of health care and social care in England.

Titled ‘The state of health care and adult social care in England 2021/22’, the State of Care report looks at the trends, shares examples of good and outstanding care, and highlights where care needs to improve.

In this year’s report, record-breaking NHS pressures, major issues with social care staff shortages, and overall health and care service deterioration are key challenges in England. While there are great examples of effective health and care delivery, the report’s foreword, by CQC Chief Executive Ian Trenholm and CQC Chair Ian Dilks OBE, describes the current health and care system as “gridlocked” and “unable to operate effectively”.

There are some examples where technology is supporting staff to deliver better health and care services, which is improving patient experiences and outcomes. However, long-term investment, funding, and planning for the health and social care sectors are needed to avoid exacerbating current issues, CQC warns.

Below, AT Today has highlighted some of the key findings from the report.

Accessing care

Overall, CQC urges that people are struggling to access care when they need it.

A lack of social care capacity means that just two in five people are able to leave hospital when they are ready, the report states. This has led to record-breaking waits in emergency departments, patients being stuck in hospital because there is no social care to support them in the community, and a lack of available ambulances as they are waiting to transfer patients.

CQC surveyed over 4,000 people aged 65 and over who had used health or social care services in the previous six months. One-fifth said they were currently on a waiting list for healthcare services. Worryingly, 41 percent said their ability to carry out day-today activities had got worse while they were waiting for care.

When people are able to access health and social care, they rate the services highly. At 31 July 2022, 83 percent of adult social care services were rated as good or outstanding, and 75 percent of NHS acute core services were rated as good or outstanding.

Workforce struggles

High staff leaving rates and difficulties retaining staff are also contributing to a stretched health and social care system that impacts negatively on patient care. These issues are prevalent are both across the NHS and social care.

According to the report, over 90 percent of NHS leaders have warned of a social care workforce crisis in their area, which they expect to get worse this winter.

In CQC’s workforce pressures survey, over one third of care home providers and two-fifths of homecare providers said that workforce challenges have had a negative impact on the service they deliver. Of the providers who reported workforce pressures having a negative impact, 87 percent of care home providers and 88 percent of homecare providers told the CQC that they were experiencing recruitment challenges.

“Without action now, staff retention will continue to decline across health and care, increasing pressure across the system and leading to worse outcomes for people,” the foreword urges.

CQC says that work needs to be done to attract and retain social care staff. It is calling for UK Government funding and support for ICSs to deliver a workforce plan that offers better pay, rewards, and training for staff.

Positive work being done

Despite a lot of negativities, the report notes that the importance of social care is being increasingly recognised by health and care leaders.

With integrated care systems (ICSs), pooled budgets, and joined-up commissioning between health and social care, this collaborative working could help ease some of the system “gridlock”, CQC states.

“Local partnerships are starting to make a positive difference – they must be focused on outcomes for people,” the report underlines.

For example, Gloucestershire set up a 24/7 clinical assessment centre. The centre involved GPs, advanced nurse practitioners, pharmacists, and paramedics working to direct patients to the right services for them, and to avoid unnecessary hospital admissions.

Similarly, in Kent and Medway a GP practice employed a wide variety of health and care professionals and was working well with community services, which was alleviating pressure on ambulance and hospital services. Good use of technology was also improving the service, as this gave quick access to patient information for out-of-hours staff.