Below is a summary of some of the key issues highlighted in the CQC's 2019 State of Care Report. The State of Care report is an annual assessment of health care and social care in England. The report looks at the trends, shares examples of good and outstanding care, and highlights where care needs to improve. The full report can be found here. 

Ratings as of 31 July 2019

The overall quality of care that people receive in England has improved very slightly from last year. When people are receiving care, it is mostly of good quality. As at 31 July 2019:

  • 90% of GP practices were rated as good and 5% as outstanding
  • 80% of adult social care services were rated as good and 4% as outstanding
  • 65% of NHS acute core services were rated as good and 7% as outstanding
  • 71% of NHS mental health core services were rated as good and 10% as outstanding.

However 4% of GP practices, 15% of adult social care services, 25% of NHS acute core services and 17% of NHS mental health core services were rated as requires improvement as of 31 July 2019.

The following were rated inadequate as of 31 July 2019:

  • 1% of GP practices (82 practices)
  • 1% of adult social care services (285)
  • 2% of NHS acute core services (43)
  • 3% of NHS mental health core services (15)[1]


Care given to people with a learning disability or autism

The report states that the care given to people with a learning disability or autism is not acceptable. People are not able to access the type of care they need, when they need it. This results in some people reaching a level of ‘crisis’ that needs immediate and costly intervention before getting the care they need, or that they end up in inappropriate parts of the system such as hospitals.

The CQC has concerns about the quality of inpatient wards that should be providing longer-term and highly specialised care for people- e.g. long term segregation as highlighted in this year’s Interim report. Since October 2018, the CQC has rated as inadequate 14 independent mental health hospitals that admit people with a learning disability and/or autism, and put them into special measures.

The report also raises concerns around staffing and workforce, with staff lacking the skills, training, experience or clinical support to care for patients with complex needs. Indeed, in the majority of mental health inpatient services rated as inadequate or requires improvement since October 2018, the inspection reports identified a lack of appropriately skilled staff as an issue. [2]


Other types of care

There is increasing pressure on all types of care. July 2019 saw the highest percentage of patients spending more than four hours in the emergency department than any previous July, alongside the highest number of people attending in any month, for at least the last five years.[3] This creates, knock-on effects and extra pressures when people cannot easily access the care they need.

The Need for More and Better Community Care Services

The report refers to the finding from the interim report on segregation, that there was a pattern of people with a learning disability or autism who had not had access to the help they needed as children from health, care and education services ending up in hospital when they situation reached a crisis point. Their stay in hospital would then end up being prolonged because of delays in setting up the package of care they needed after they were discharged.[4]

Variation across the country

The report notes that there are parts of the country where relative concentrations of poor quality care, as shown by ratings, mean that people living there may find it more difficult to access good care. For example in Portsmouth only 18 out of 30 rated homes (60%) are good or outstanding.[5]

Funding and Commissioning Issues

The stability of the adult social care market remains a particular concern. The percentage of services rated as good or outstanding has improved very slightly this year, but there are fewer beds in nursing homes and care homes, and staff turnover has risen for the sixth year running.

CQC staff have reported that the complexity of commissioning and funding arrangements is a key issue in both mental health and adult social care. Local commissioning arrangements can lead to fragmented, confusing pathways and people not accessing the right service in the right place and at right time.[6]

The report advocates for local health and social care providers to work together, to improve people’s experience of care.

Innovations in care

Report notes that encourages and supports innovation that improves the quality of care for people and puts their safety first. Lots of focus on how tech-enabled care has the potential to improve people’s care experience.

Deprivation of Liberty Safeguards

Local authorities continue to deal with high volumes of applications under the Deprivation of Liberty Safeguards (DoLS), often with limited resources. This can lead to people waiting too long, and risks infringing their human rights.

The gap between the number of applications received and those completed narrowed between 2014/15 and 2017/18. We have seen that good communication and partnership working between local authorities and providers can support the implementation of the DoLS process.

Lack of understanding and confusion around the DoLS legislation remains one of the primary reasons for poor practice among providers. While we have seen some evidence of increasing awareness through our inspections, progress has not been good enough.

Involving a Relevant Person’s Representative and consulting friends, families and carers in the DoLS process can be key to making sure the person’s human rights and needs are kept at the forefront. However, we have heard that the process can be confusing and families can experience a lack of information. Involving these groups will be even more important as the Liberty Protection Safeguards come into force in October 2020 and care provided in people’s own homes comes into scope.

Clear and committed leadership and culture around DoLS and the Mental Capacity Act, alongside in-depth and practical training, can help staff to engage better with the legislation. Training and culture will play an important part in providers preparing their staff for the new Liberty Protection Safeguards legislation.[7]

[1] P.9

[2] P.6

[3] P.12

[4] P.19

[5] P.20

[6] P.21

[7] P. 94

Image Credit : CQC Twitter Account