CQC has published its annual report into the state of health care and adult social care and whilst it appears that the sector was rated more highly than last year’s report, it continues to face a multitude of challenges.
The ratings of services features prominently within the report, at the end of July 2016 72% of providers were rated good or outstanding– an increase of 12% on last year’s figures- and 2% were rated inadequate- a reduction from 7% at the same time last year. This improvement still leaves just over 1 in 4 services failing to meet the expected standard.
Another pertinent observation is that smaller providers generally perform better than their medium and larger counterparts. CQC’s registration data states that there has been a 12% drop in 1-10 bed homes registered and a 27% rise in large homes with over 50 beds since 2010. This suggests a consolidation of the market in favour of larger providers who by virtue of their size, appear to have an increased propensity to be awarded lower ratings.
There has been a 47% increase in the number of domiciliary care agencies from just under 6,000 to over 8,500; conversely there has been a loss of 12% of residential (non-nursing) care homes and a reduction in the number of beds by 8% to 235,799. CQC makes the observation that it draws the conclusion that people are increasing their use of domiciliary care or failing to access care services in light of increasing costs.
The picture for nursing home beds sees an increase of 9% to 224,843 over the last 6 years; this trend appears to have stopped in the past 16 months. There also appears to be an increasing shift of providers to move from presences in the north of England to southern regions where the propensity to be able to pay self-funded fees is greater.
Between October 2010 and December 2015 2,444 care homes have closed with 1,433 (59%) being small (1-10 bed); compared with 980 (40%) medium 11-49 bedded homes; with just 31 large (50 bed plus) homes having met the same fate.
The performance of providers in relation to the question is the service caring? was overwhelmingly positive but provider performance is much worse when looking at the questions relating to leadership and safety. These areas should be focussed on by providers to ensure that they are given the best possible chance to achieve favourable ratings from CQC. 1 in 3 of all care homes that are rated requires improvement or inadequate received a similar rating for the leadership question. CQC advises that management can create a supportive environment for staff, they can ensure they are available to staff and used the positive example of frequent walks around the service and actively involving themselves in the daily operation of the service.
CQC maintain that their system of inspection and enforcement drives change through providers of adult social care. It states that following re-inspection of providers rated as inadequate over three in four improve their rating and of those a third see their rating improve from inadequate to good. The picture is not quite as good for those services that are rated as requires improvement. Only 43% of these providers see their ratings improve on re-inspection and 49% of providers don’t see their rating change; 8% see their ratings decline to inadequate. It seems to be clear that a provider takes adequate notice to address concerns when awarded inadequate but fail to take similar levels of action when awarded requires improvement.
CQC clearly sends the message in this report that those services rated as requires improvement need to do more to demonstrate they are worthy of a better rating at re-inspection; or they will face the increased pressure of retaining the rating or being downgraded further. One way to combat this would be for services to focus their efforts on issues around leadership and safety in order to increase their likelihood of being awarded a rating of good. Another way would be to treat the awarding of requires improvement in the same way as a rating of inadequate.
This report describes the adult social care sector as one which is improving but is also becoming increasingly more concentrated. This is not necessarily a good move as the findings suggest larger operators are more likely to perform worse on inspection. The domiciliary care sector is growing and seems to be the preferred option for service users with low care needs; though this decision seems to be borne out of affordability rather than need.