For anyone reading ahead of the Queen’s speech, there might have been a little flutter of excitement – as the weekend papers talked of big news for social care, promises of legislation and details of how care might be funded. The reality on the day – yet another promise of jam tomorrow.
The Queen stated – ‘My government will bring forward proposals to reform adult social care in England to ensure dignity in old age’. Well, that sounds a lot like the waiting game continues. Anyone rushing to the briefing note for greater enlightenment will have been even more disappointed to note that the ‘reform’ agenda for social care sits under a sub heading of – you guessed it – ‘Supporting the NHS’!
Aside from the obvious alarm that the government appears to have gone backwards in its understanding of adult social care, reverting back to green paper announcement version 1 (cast your mind back a year or two) which only looked at older people, there is the additional worry that there is no timescale attached to this reform.
When was the sector that supports millions of people receiving or giving care, and that employs over 1.5 million people is relegated from the ‘steps of downing street’ priority list to the too difficult to promise pile? If, as is widely suggested, we should read this as an outline manifesto for any future Conservative government, then the time for action is now. Local MPs, Peers, Ministers, Secretary of States and the Prime Minister should be under no doubt that social care is an electoral priority and that reform cannot wait.
If we needed further evidence of the need for immediate attention, then the arrival today of the CQC State of Care 2019 report should leave us in no doubt. This annual aggregation of learning from inspections across the health and care sector gives us the hard data that underpins the argument for change now. The State of Care report highlights again the pressures across the health and care system, workforce shortages and the urgent need for system wide workforce planning to provide stability in the sector. It adds its voice to the imperative for a long-term sustainable funding solution, seeing it as an essential element to provide stability in the social care sector. It also draws attention to the need for better integrated community services. The overall picture the report paints for the care sector is one of perpetual challenge. There is widespread unmet need, providers are continuing to exit the market and CQC has twice had to exercise its legal duty to notify local authorities of a credible risk of service disruption due to provider business failure (utilising their market oversight function). There are decreases in both residential and nursing homes, and ongoing growth of the domiciliary care market.
The report shines a much needed light on the dire consequences for people with a learning disability or autism not being able to access the right care and how that can mean that they end up detained in unsuitable hospitals. CQC’s ongoing thematic review, which began in 2018, highlighted the prolonged use of segregation for people with severe and complex problems who should instead be receiving specialist care from staff with highly specialised skills.
The report does celebrate some success, and recognises that despite all this, there has been some improvement in the ratings for adult social care, with 80% of services now being rated good or outstanding. In addition, there is a strong focus in the introduction around innovation and the use of technology. We know that this sits alongside a number of recent initiatives that CQC has launched around ‘sandboxes’ for innovation. Reinforcing the adage that technology must be an enabler, rather than a driver of high quality care, the report provides an encouraging narrative about the role of technology in care, but guards against the ongoing piecemeal approach to adoption and the lack of joined up thinking in this area between commissioners and providers. All sentiments that we would echo.
It is hard to hold the CQC report – detailed and diligent in its findings on the state of care and the urgency with which reform needs to happen – alongside a timetable for parliamentary priorities which appears to kick the social care can once more down the road. Mr Johnson – if you are listening – this is a nation that can wait no more…