An ongoing combination of workforce and financial pressures across community and social care services is having a detrimental impact on the quality of people’s care, with some ‘at greater risk’ of going without the support they need, a new report by the healthcare watchdog has warned.
The Care Quality Commission (CQC) has today published its latest state of health and adult social care in England report, uncovering a wave of fresh concerns about staff shortages, the cost-of-living crisis and poor management.
Staff working across health and social care settings ‘regularly’ feed back to the CQC about being ‘overworked, exhausted and stressed, sometimes to the point of becoming ill, injured or leaving their job altogether’, according to the report.
And they warn how ‘low staffing levels can affect their ability to provide safe and effective care to people’.
The situation facing adult social care services seemed particularly concerning, as the healthcare watchdog repeated warnings that ‘insufficient capacity’ in the sector was ‘continuing to contribute to delays in discharging people from hospital’.
In August 2023, there were nearly 12,000 patients waiting in hospitals who no longer needed to be there, the report noted.
In addition, there have been cases are people have been ‘discharged too early, without appropriate risk assessment or having a care package or intermediate care in place’.
Adult social care services funded by local authorities were ‘increasingly struggling to keep up with demand’, the CQC said.
NHS England data showed the total number of new requests to councils for adult social care support increased by 3% between 2020/21 and 2021/22 to reach nearly two million requests, it added. However, of the requests made for services, more than half a million (568,685) did not result in additional support.
‘Ongoing staffing and financial pressures in residential and community services are having an impact on the quality of people’s care, with some at greater risk of not receiving the care they need,’ the CQC found, with care home staff feeling ‘unable to provide adequate care and support due to a shortage of staff, lack of funds and absent or poor management’.
The report also found that some providers in adult social care were struggling to pay their staff a wage in line with inflation, with over half of respondents to a CQC survey admitting they were having challenges recruiting new staff, and 31% experiencing challenges in retaining them.
Many adult social care services described difficulties attracting new staff to roles to fill the vacancies, the CQC found, ‘citing low pay, high pressure, and staff burnout as key causes of the many care workers who are leaving the sector for better paid jobs in less pressurised environments’.
The CQC said ‘local authorities are concerned about risks to their care workforces, but they recognise that workforce development is important for their strategies – especially recruitment and retention of staff’.
Aspects affecting the wider system include ‘a lack of nursing staff and the importance and growth of the homecare workforce to enable appropriate hospital discharges and the move to more care in the community, where it can meet people’s needs,’ it added.
Risks of ‘unfair care’
The CQC warned that a combination of the cost-of-living crisis and escalating workforce pressures ‘risks leading to unfair care’ – where those who can afford to pay for treatment do so and those who can’t, face longer waits and reduced access.
Research from YouGov showed eight in 10 of those who used private healthcare last year ‘would have previously used the NHS’, noted the CQC, with ‘separate research showing that 56% of people had tried to use the NHS before using private healthcare’.
‘The danger is that the combination of the cost of living crisis and workforce challenges exacerbate existing heath inequalities, increasing the risk of a two-tier system of health care,’ said the report.
‘People who cannot afford to pay could end up waiting longer for care while their health deteriorates,’ it added.
Whole system ‘in turmoil’
Royal College of Nursing chief nurse Professor Nicola Ranger said the report revealed ‘the shocking state of care’ and that the ‘whole system is in turmoil’.
‘Health and care services can no longer be there for us when we need them,’ she said.
‘This is the damning consequence of ignoring nursing staff and not listening to their warnings about services they work in every day.’
She added: ‘A chasm of inequality is growing in accessing care – with more people being forced to go private simply to get treatment.
‘This has been a long time coming but fixing it must come quickly.’
Professor Ranger warned that the workforce crisis was ‘at the heart of the issue’.
‘There aren’t enough nursing staff, meaning those in the system are spread too thin, unable to give the outstanding patient care they strive to deliver,’ she said.
A recent report by Skills for Care recently highlighted that the turnover rate for registered nurses working in adult social care in England was around three times higher than the NHS.
Meanwhile, nurse vacancies across the NHS in England rose to more than 40,000 earlier this year.
Concerns have also been raised in recent months around a ‘seriously worrying’ lack of growth in general practice nurse (GPN) numbers in England.
Also commenting on the CQC’s findings, Nursing and Midwifery Council chief executive and registrar Andrea Sutcliffe said the report was ‘another stark reminder of the struggles people face in accessing high-quality care’.
‘And as workforce pressures continue, the findings show just how crucial it is that professionals have the right support and resources in place to deliver the safe, kind and effective care everyone, especially those in the most vulnerable circumstances, deserves,’ she added.
Ms Sutcliffe stressed nurses, midwives and nursing associates made an ‘essential contribution to people’s health and wellbeing’, but she warned it was ‘clear they need adequate resource and the right support and leadership to provide the best care they can’.
