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21 October 2020

On 15 October 2020, the Care Quality Commission published their annual report, ‘The state of health care and adult social care in England 2019/20’. The report looks at the state and quality of health and social care in England over the past year. You can access the report in easy read here.


What is the Care Quality Commission?

The Care Quality Commission (CQC) is the independent regulator of health and adult social care in England. It monitors, inspects and regulates health and social care services to make sure they “provide people with safe, effective, compassionate, high-quality care” (CQC website, ‘About Us’). The CQC sets standards of what good and outstanding care looks like and is tasked with ensuring health and care services meet fundamental standards. It also publishes information on the services they regulate so that people are more informed when accessing health and care services. The services which the CQC regulate include:

  • Hospitals
  • GPs and doctors’ surgeries and dentists
  • Care homes
  • Mental health services, including those for people who are detained under the Mental Health Act
  • Children’s health and care services (working with other relevant inspection organisations)

See the CQC’s website for the full list of services they regulate and to find out more about what they do.


What is the CQC report?

Under the Health and Social Care Act 2008, the CQC must publish a report every year on how it has exercised functions and the provision and health and social care that year. The ‘state of health care and adult social care in England 2019/20’ report is this report. In other words, it looks at the state and quality of care in health and social care services in England in 2019 and 2020.

This year, in light of the Covid-19 pandemic and the wide-ranging impact this has had on our health and care services, the report looks at the state of care pre-Covid-19 (between October 2019 and 31 March 2020) and since Covid-19 (from April to October 2020).

 

What are the key findings of the report?

The ‘state of health care and adult social care in England 2019/20’ report (“the report”) found that the people generally received good quality care in 2019/20. The quality of care received this year is largely the same as last year, but with generally no overall improvement.

Mental health, learning disability and Autism: The report raises particular concerns about mental health services, with poor care found more in inpatient wards for people with a learning disability and/or autism. There was a rise in the proportion of these services rated ‘inadequate’ by the CQC – from 4% in 2018/19 to 13% in 2019/20. An ‘inadequate’ rating by the CQC means a service is performing badly and that the CQC have taken action against the person or organisation that runs it.

The pandemic is found to have had a significant impact on people’s mental health and wellbeing and on the care that people with mental health conditions have received. The report finds that “some autistic people were feeling more anxious due to not being able to follow their usual routines”. The CQC helpline received an increased number of calls about, or from, people detained under the Mental Health Act. For people with severe mental health conditions, there have been delays in being discharged into the community and a lack of community placements available.

Social care fragility and inequalities: Even before the Covid-19 pandemic started, the social care sector was found to be fragile from a lack of long-term funding. What’s more, persistent inequalities were found in some types of care and there was “considerable variation between different areas and services in how well they consider the needs of people from different groups – particularly people from Black and minority ethnic groups, people from religious groups and disabled people”.

Deprivation of liberty: Research the CQC carried out before the start of the pandemic showed that there had been some improvements in services’ awareness and understanding of the deprivation of liberty laws. These laws should protect people’s human rights when they have restrictions placed on them due to mental capacity issues. Some improvements in the 2020 report included taking safeguarding action when CQC inspectors raised concerns and greater accountability amongst managers for addressing poor practice. However, the report says “despite years of the legislation being in place, there is still huge variation in understanding and practice … training remains an area of concern, with huge variety in its quality. Training did not always consistently provide staff or services with the understanding, level of awareness or practical knowledge to effectively embed learning into practice.”

Adult social care: With Covid-19, the report notes that for people receiving care in adult social care services, the impact of pandemic has been particularly severe. In particular, there has been a disproportionate impact on care for older people, with big changes for people living in care homes due to measures introduced to try and control the spread of the virus. For example, visits from friends and family were stopped, social events were cancelled, residents were confined to their rooms and some social shared areas in certain homes closed. For people living in care homes this means many have not received the emotional support from family, friends and loved ones that they normally would, leading to increased loneliness and stress.

Pandemic and inequality: The report finds that the Covid-19 pandemic has had a disproportionately negative impact on some people with protected characteristics, particularly: “people from Black and minority ethnic backgrounds, older people, and people with some long-term health conditions and other disabilities”. Both health and social care workers and people in need of care fall into these groups and they have been hit harder by the pandemic and its knock-on effects.

Collaborative working: The report also provides insight on the collaboration of care providers in their response to the pandemic, and how effectively care providers managed to keep people safe. While the success of collaboration was found to be varied, the report says “health and social care staff worked above and beyond, with a shared drive to look after people well and keep them safe.”


Report Conclusions

The report makes a number of findings in each section. It finishes with a “Looking Forward” section which notes:

  • Problems that existed before COVID-19 have not gone away.
  • Designing services around people’s needs is critical.
  • People working in adult social care across health and care services need clear career progression and skills development, better recognition of staff, and investment in their training and supports appropriate professionalisation.
  • GPs, dentist, opticians, pharmacies (“primary health care”) need to make sure that people and patients are given the confidence to interact with them early in different and easy ways.
  • The increased waiting lists and backlog of urgent and elective care need to be addressed, prioritising patients according to clinical need and making sure those waiting for long periods for treatment are kept safe.
  • Using the learning from the pandemic to lock in positive changes, and drive a new way of working that is supported at a national, regional and local level by the whole health and care system.

Overall, the report finds that the problems in our health and social care system in England that existed before the pandemic have not gone away. What this means is that “people are still more likely to receive poorer care from some types of service, and from some providers, for the same reasons that they would have been more likely to receive poorer care before”. The report calls for the learning gained during the pandemic be used “to lock in positive changes, and drive a new way of working that is supported at a national, regional and local level by the whole health and care system.” This is particularly so in light of the disproportionate impact of the pandemic on those who were already more likely to have poorer health outcomes. Services need to be designed around people’s needs.


What does this mean for human rights?

Hospitals and care services are public bodies, or bodies carrying out a public function. Public bodies have legal duties to protect, promote and fulfil our human rights under the Human Rights Act. The Human Rights Act is about everyone’s rights, including those accessing health and care services. It sets out basic rights that belong to all people in the UK, many of which are impacted by the issues covered in the report:

  • The right to life (Article 2), e.g. responses to Covid-19 and investigating the differences in outcomes for people from different groups
  • The right to be free from torture, inhuman and degrading treatment (Article 3), e.g. where people have received undignified care, including due to neglect or abuse
  • The right to liberty (Article 5), e.g. where people have been detained or had their liberty restricted inappropriately
  • The right to respect for private and family life, home and correspondence (Article 8), e.g. where people have had inappropriate restrictions on their relationships with families and loved ones, where wellbeing is compromised, where decisions about their care, health and living arrangements are made inappropriately
  • The right not to be discriminated against in relation to any of the rights in the Human Rights Act (Article 14), e.g. where people are treated worse because of a particular identity or characteristic.

You can read more about the Human Rights Act here.


What happens now?

The CQC will continue to monitor the state of care in England and publish their next annual report in autumn 2021.

The CQC’s regulatory duties have not changed during the pandemic, although different methods of inspection and regulation have been used in response with in-person inspections put on hold. In-person inspections in care homes are being restarted, with calls for inspectors to have Covid-19 tests before going into care homes being raised.

This week, the CQC will publish work on their review into the use of restrictive interventions in places that provide care for people with mental health problems, a learning disability and/or autism. The review is called “Coronavirus (COVID-19): Impact on our restraint, segregation and seclusion review” and should be published on 22 October 2020. Keep an eye on the CQC website for this.


Where can I find more information?

Banner image credit: the Care Quality Commission