CQC observes “varying ability” of local authorities to plan for care their communities need

In this year’s State of Care report, the CQC warned that demand for health and adult social care continues to grow, and in many areas, including community mental health services, need is also becoming more complex.

According to the report, children and young people are experiencing some of the sharpest increases in need and waiting times, even as some adult waiting times have improved.

This is illustrated in community health services, where more than 80,000 children and young people – almost 11 times the number of adults – have been waiting over a year for an appointment. Meanwhile, the number of children waiting for their first contact with mental health services rose 31% in two years.

Looking at adult social care, the report described the market as “changing rapidly”. The CQC said: “Underpinning much of this change is the varying ability of local authorities to plan for the care their communities need in line with a clear strategy, alongside a funding model that remains fragile.

“This is leaving care providers and local authorities exposed to pressures that are reshaping the market by accident rather than design.”

The report highlighted commissioning as one of the most powerful levers to drive quality, equity and sustainability in social care.

The CQC said: “Where it is done well, it can make a real difference to people’s care both now and in the future. In Wigan, CQC’s assessment rated the council as outstanding, as it worked collaboratively with providers and people who use services to shape the local market and tackle health inequalities.

“By developing more local provision, it reduced reliance on care placements outside the borough. Its reablement service, rated outstanding and delivered jointly with health partners, means fewer people need ongoing support a year after leaving.”

The report warned however that within the changing market, some local authorities are struggling to meet people's needs, and providers are increasingly seeking people who can self-fund their care in order to remain viable.

“This risks reducing choice and capacity for people who rely on council-funded support, which is already subject to significant regional variation”, the CQC noted.

Looking at Deprivation of Liberty Safeguards, the report warned that the operation of DoLS over the last decade has been characterised by an increasing volume of applications and “sustained backlogs”.

The CQC said: “We continue to find variation in the way health and social care settings apply and understand DoLS, with issues identified around training, communication, record keeping as well as recognising and reviewing restrictions.”

The report covered a period before the Supreme Court's ruling in June this year in the AGNI case, which set out a revised approach to establishing whether a person is deprived of their liberty.

The CQC noted that this development brings “significant implications” for how DoLS will be applied, now and in the future.

Chris Badger, Chief Inspector of Adult Social Care and Integrated Care, said: “This year's State of Care report finds the social care market changing shape rapidly, while inequalities persist across the whole health and care system.

“In social care, we're seeing sharply divergent trends, with more of the available care home beds concentrating in large homes, alongside a recent increase in institutional investors acquiring care homes - while homecare fragments into a growing number of smaller providers. This reshaping is happening largely by accident rather than design; driven by a combination of economic pressure and local authorities' differing abilities to plan for and shape the care their communities will need.

“A clearer vision is needed. In addition to the sustainable funding solution CQC has consistently called for, commissioning needs to improve so the market can be shaped around what's best for people, and in a way that ensures care staff can be employed fairly. Our assessments of local authorities have found that done well, commissioning can help build more resilient care markets where more people are helped to stay out of hospital and get care closer to home. Investment in leadership capability is also needed – well-led services deliver safer, better care.”

Responding to the report, Phil Holmes, President of the Association of Directors of Adult Social Services (ADASS), said: “This report shows how hard councils and care providers work to maintain high standards, with the majority being rated as Good or better.

“[…] The report also sets out what happens when good standards are not reached and the actions that need to be taken to address this. Alongside this the CQC have described the context in which adult social care takes place, with councils overspending and, in spite of this, decreasing numbers of people receiving support. The impression given is of adult social care trying to run forwards as fast as current resources allow, but nevertheless continuing to be pushed backwards in the face of ever-increasing demands."

Holmes added: "The sustainable improvement that our population and our workforce deserve will require both structural change and sustained investment in the staffing, services and local systems that make high-quality care possible.”

Lottie Winson