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The state of health care and adult social care in England 2015/16

13 October 2016

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 October 13, 2016
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Dear colleague

The state of health care and adult social care in England 2015/16

Today we have published our annual report to Parliament on the quality of health and social care in England. 

This year’s report shows that, despite increasingly challenging circumstances, much good care is being delivered and encouraging levels of improvement are taking place.

We have seen services providing good and outstanding care and making improvements by collaborating outside traditional organisational boundaries – hospitals working with GPs; GPs working with social care and all services working with people who use services. 

However, we are also seeing some deterioration in quality, and some services are struggling to improve. 

We raise concerns that the sustainability of the adult social care market is approaching a tipping point. The fragility of the market is now beginning to impact both on the people who rely on these services and on the performance of NHS care. The combination of a growing and ageing population, more people with long-term conditions, and a challenging economic climate means greater demand on services and more problems for people in accessing care.

Click here to see the report on our website.

Our key findings 

Most health and adult social care services in England are providing good quality care, despite a challenging environment, but substantial variation remains.

  • As at 31 July 2016, 71% of the adult social care services that we had inspected were rated good and 1% were rated outstanding. Of the GP practices we inspected, 83% were rated as good and 4% as outstanding, and 51% of the core services provided by NHS acute hospital trusts that we inspected were rated as good and 5% as outstanding.
  • However, some people still received very poor care. We rated a minority of services as inadequate: 2% of adult social care services, 3% of GP practices and 5% of hospital core services.

Some health and care services are improving, but we are also starting to see some services that are failing to improve and some deterioration in quality.

  • Of those services that we re-inspected following an initial rating of inadequate, 76% achieved an improved rating: 23% went from inadequate to good and 53% went from inadequate to requires improvement.
  • However, this still means that a quarter of services originally rated inadequate that did not improve enough to change their overall rating on re-inspection. In addition, 47% that were re-inspected following a rating of requires improvement did not change their rating. In 8% of cases, the quality of care deteriorated so much that we rated it inadequate.

The majority of GP practices are providing good quality care and leading the change in service design.

  • Despite a context of increased demand, coupled with a shortage of GPs and increasing vacancy levels, 83% of the GP practices we have rated so far are good and 4% are outstanding. Some general practices have joined together in federations and formed new models of care, involving people who use their services in their conversations from an early stage.

Adult social care services have been able to maintain quality, but there are indications that the sustainability of adult social care is approaching a tipping point.

  • Of the care homes and home care agencies that we had rated as inadequate, 77% had improved when we re-inspected. We are seeing some providers starting to hand back home care contracts as undeliverable. 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.
  • We are concerned about the fragility of adult social care and the sustainability of quality. This is a serious issue for the continuity and quality of care of people using those services, and for the knock-on effects across the whole health and care system: more A&E attendances, more emergency admissions, more delays to people leaving hospital, and more pressure on other services.

Hospitals are under increasing pressure

  • Despite financial challenges, we have found much good and outstanding care, particularly in children’s and young people’s services and critical care.
  • But we have also found too much acute care that we rated inadequate, particularly urgent and emergency services and medical services. It will be increasingly difficult for NHS trusts to make improvements to these services unless they are able to work more closely with adequately funded adult social care and primary care providers.
  • The quality of care received in NHS mental health trusts is broadly similar to that in acute trusts, but with an even higher level of variability within providers as well as between them, and with particular concerns around the safety of acute mental health services.

Part two of the report includes a more detailed account of the quality of care we have observed in each of the sectors we regulate. Click here to view the adult social care section of the report on our website.

The sustainability of quality

Our evidence suggests that finance and quality are not necessarily opposing demands; many providers are delivering good quality care within the resources available, often by starting to transform the way they work through collaboration with other services and sectors. However, sustained support will be needed for new models of care to become established and improve, and investment will be needed to support leadership and enable the desired transformation.

We will continue to highlight good and outstanding care, to support improvement and to take action to protect people where necessary. And we will continue to use the unique and detailed information we hold on quality, to help those that lead, work in and use health and care services to make the right decisions.

People have a right to expect good, safe care. Working with our partners, we will offer whatever support we can to make the changes necessary to ensure high-quality care into the future. I hope you find our report of interest.

Yours sincerely, 

Peter Wyman                                                                  David Behan

Chair                                                                               Chief Executive

Care Quality Commission                                                Care Quality Commission

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