Most services meet the ‘Mum Test’ but there is still too much poor care, finds CQC
While the majority of Adult Social Care (ASC) services are safe and of a high quality and many are improving, too many people across London and England as a whole are living in care homes and receiving care and support in their own homes that is not good enough.
Without a proper recognition of the importance of adult social care and a renewed commitment to quality, the numbers of people affected by poor care could increase and have a profound impact on their lives.
In a national report, published today (Thursday 6 July 2017), called ‘The state of adult social care services 2014 to 2017’, the Care Quality Commission (CQC) has found that over three-quarters of ASC services are currently rated as Good (77%, 16,351) and 2% (353) are currently rated as Outstanding.
In London there are a total of 2,252 ASC services – 78% were rated as Good overall. A total of 20% were rated as Requires Improvement, while one percent were Outstanding and one percent were Inadequate.
London’s best performing local authority areas for ASC are: Camden, City of London, Croydon, Kingston, Lambeth, Richmond and Southwark. The worst are Barking & Dagenham, Barnet, Ealing, Hackney, Haringey, Newham, Tower Hamlets and Westminster. There are more London statistics on pages 10, 11, 12, 13 and 14 of the attached report.
CQC has found that strong leaders – both at provider and registered manager levels – play a pivotal role in high-performing services, where a strong vision and person-centred values inspire staff, encouraging a culture of openness and transparency. Staff members are capable, confident and caring and are focused on supporting people to live the best lives they can.
However, CQC has found considerable variation with nearly a fifth (19%, 4,073) of services being rated as Requires Improvement and 2% (343) as Inadequate.
This is the first time that such focused analysis on a national scale has been possible following the formal introduction of CQC’s new regulatory regime for adult social care in October 2014, with expert-led, specialist inspections that focus on what matters most to people using services – are they safe, caring, effective, responsive and well-led? CQC then rates services as Outstanding, Good, Requires Improvement or Inadequate so that the public and providers are clear about its judgements.
Since then, CQC has carried out over 33,000 inspections of around 24,000 different services – many more than once. These include residential homes, nursing homes, care in people’s own homes, Shared Lives schemes and supported living services. These are vital services for thousands of people, young and old, who may be living with a physical disability, learning disability, autism, dementia and/or mental health conditions.
CQC found the adult social care sector performed best in how ‘caring’ its services were, with 92% being rated as Good and 3% as Outstanding in this key question. In these services, CQC found staff building meaningful relationships with the people who they care for over time and treating them with compassion, kindness, dignity and respect.
Safety is where CQC has found its greatest concerns, with 23% of services being rated as Requires Improvement and 2% as Inadequate in this key question. Issues uncovered by CQC include ineffective systems and processes for managing medicines or determining staffing levels, which can result in people not getting their prescribed medicines, call bells not being answered, and home visits being rushed or missed.
CQC has used its inspections and ratings to help providers of adult social care understand the specific areas where improvements are needed, to hold them to account to make these necessary changes, to celebrate best practice and to help people to make informed choices about their care.
Already, CQC’s actions are driving improvements in care for people. Of the 686 services that were originally rated as Inadequate and have been re-inspected, more than four in five (81%, 553) improved their overall rating. However, this does still mean that nearly a fifth of services have not improved and further action is required.
CQC has not seen the same rate of improvement in services that were rated as Requires Improvement initially, where only 56% of the services eventually improved to Good, with others failing to improve and some deteriorating.
Worryingly, 26% of the services that were first rated as Good and have been re-inspected have deteriorated. While these are a small proportion of services that were originally rated as Good, it shows that providers cannot always sustain this level of good practice within their services and that as a whole; the sector continues to be fragile at a time when more people are expected to need its services.
Andrea Sutcliffe, Chief Inspector of Adult Social Care at the Care Quality Commission, said: "When CQC began to transform its regulation of adult social care in England, I asked my staff to consider whether every service they were inspecting was good enough for their Mum or anyone they loved. The ‘Mum Test’ has guided our work ever since and made sure that we always focus on the people who are most important – people who use services, their families and carers.
"Having carried out over 33,000 inspections of around 24,000 different services, most of the adult social care sector is meeting the Mum Test, providing safe and high quality care that we would be happy for anyone we love, or ourselves, to receive. This is thanks to the thousands of dedicated staff and providers who work tirelessly to ensure people’s care is truly person-centred and meets their individual needs.
"However, there is still too much poor care, some providers are failing to improve, and there is even some deterioration.
"It appears to be increasingly difficult for some providers to deliver the safe, high quality and compassionate care people deserve and have every right to expect. With demand for social care expected to rise over the next two decades, this is more worrying than ever.
"Last October, CQC gave a stark warning that adult social care was approaching a tipping point. This was driven by more people with increasingly complex conditions needing care but in a challenging economic climate, facing greater difficulties in accessing the care they need.
"While this report focuses on our assessment of quality and not on the wider context, with the deterioration we are seeing in services rated as Good together with the struggle to improve for those with Inadequate and Requires Improvement ratings, the danger of adult social care approaching its tipping point has not disappeared. If it tips, it will mean even more poor care, less choice and more unmet need for people.
"The announcement in the Chancellor’s budget statement of £2 billion additional funding over the next three years is welcome but even more welcome is the promise of a Government consultation this year, which hopefully will lead to a long-term solution to support good quality, person-centred adult social care, both now and into the future.
"Quality must be at the heart of the long term reform of social care in England. CQC will continue to keep its relentless focus on quality with regulation becoming more targeted, risk-based and intelligence-driven over the next few years. But we cannot do it alone. Everyone must play their part in making sure quality matters and that adult social care services provide care that we would all be happy to use."
Margaret Willcox, President of the Association of Directors of Adult Social Services (ADASS), said: "This report recognises that there is a lot of great care provided by committed leaders and staff through high quality services to people in care homes and in their own home.
"Our recent 2017 budget survey shows that whilst extra funding is very welcome, it doesn’t meet increasing needs and costs, that 74 per cent of directors report that providers face quality challenges and that 69 per cent of councils had experienced provider failure or returned contracts.
"The risk of adult social care approaching its tipping point is still real and we will focus on re-doubling our mutual efforts to ensure that the quality of care doesn’t deteriorate and that older and disabled people and their families get the reliable, personal care they need and deserve."
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