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The state of health care and adult social care in England 2016/17

This year’s State of Care shows that the quality of health and social care has been maintained despite very real challenges. The majority of people are getting good, safe care, and many individual providers have been able to improve. However, future quality is precarious as the system struggles with increasingly complex demand, access and cost. The efforts of staff have largely ensured that quality of care has been maintained – but staff resilience is not inexhaustible, and some

services have begun to deteriorate in quality.

With the complexity of demand increasing across all sectors, the entire health and social care system is at full stretch. The impact on people is particularly noticeable where sectors come together – or fail to come together, as the complex patchwork of health and social care strains at the seams: the teenager detained under the Mental Health Act because she’s been unable to access the support she needs in the community; the elderly man unable to leave hospital because there’s no home care package in place for him; the stroke victim waiting for an ambulance that’s delayed because the crew are still waiting to get their previous patient into A&E.

Last year, we said that social care was approaching a ’tipping point’ – a point where deterioration in quality would outpace improvement and there would be a substantial increase in people whose needs were not being met. We said this based on five pieces of evidence – on quality, bed numbers, market fragility, unmet need and local authority funding. What this year’s report suggests is that while, in some areas of the country, care has moved further away from a tipping point, in other areas it has moved closer to that point.

The additional £2 billion made available by the Chancellor in the Spring budget was a welcome acknowledgement of the pressure the adult social care sector is under. What is now required is a longterm sustainable solution for the future funding and quality of adult social care. The future of care for older people and the adult care system is one of the greatest unresolved public policy issues of our time; the anticipated government green paper on adult social care will provide the opportunities

for Parliament, the public and professionals to consider how we should collectively develop an appropriately funded social care system that can meet people’s needs now and in the future.

There are other opportunities to address this fragmentation. In children and young people’s mental health services, CQC’s review is finding that a complex system, where care is planned, funded, commissioned, provided and overseen by many different organisations who do not always work together in a joined-up way, can result in situations where a child’s mental health reaches crisis point before they get the help they need. And our report on the state of mental health services highlighted the high number of people isolated in locked mental health rehabilitation wards away from their friends and family. But the Five Year Forward View for Mental Health sets out a compelling vision for the future, and the forthcoming government green paper on child and adolescent mental health services and the review of the Mental Health Act provide a chance for genuinely transformational change to these important services.

The NHS is 70 years old next year. In its first year of existence, Aneurin Bevan voiced concerns about “the increasing demand made on our hospitals by the aged sick“. Today, the system faces similar challenges – as it tries to meet the needs not only of older people, but people with increasingly complex conditions: diabetes, obesity, cancer and long-term degenerative conditions. The response to these challenges must be through personalisation of care, achieved through better coordination. We have seen excellent examples of services working together around the needs of people – often harnessing new innovations and technology – with positive results on outcomes, access and people’s experience of care.

To deliver good, safe, sustainable care, more providers need to think beyond traditional boundaries to reflect the experience of the people they support. Leadership and support at all levels – system, organisation, service and practice – will be crucial.

To truly coordinate care, local system leaders must ensure there is a golden thread linking vision to delivery, so that everyone involved can not only share the vision

but see themselves as part of the team that delivers it. And collaboration must happen not just between sectors but between local agencies and professionals, and be supported and incentivised by the national health and

care organisations.

CQC will encourage the move towards coordinated care by increasingly reporting not just on the quality of care of individual providers, but on the quality of care

across areas and coordination between these areas, reflecting how people access and experience this care.

Our findings will highlight what is working well and where there are opportunities for improving how the system works, enabling the sharing of good practice and

identifying where additional support is needed to secure better outcomes for people using services. And we will continue to celebrate good care, support improvement, and take action to protect people where we need to.

This year’s assessment of the quality of health and social care contains much that is encouraging – the fact that quality has been maintained in the toughest climate most can remember is testament to the hard work and dedication of staff and leaders. Many services that were previously rated as inadequate have recognised our inspection findings, made the necessary changes and improved.

Safety continues to be a focus of our work, but we have also seen improvements where providers have clear systems and governance in place that enable learning and improvement from safety incidents, and where staff are encouraged to raise concerns.

A great deal has been achieved in exceptionally challenging circumstances. We must now build on this in order to realise a future where people receive a consistently good quality of care and are able to access that care when they need it – whether that’s delivered in an acute hospital, a nursing home, a community mental health hospital, a GP surgery or a person's own home. We know that staff and leaders can’t work any harder. Everybody’s focus must now be on working more collaboratively – looking out, not just in – to create a sustainable and effective health and care system for the third decade of the 21st century.