People are struggling to get the care they need, when they need it: CQC’s State of Care Report

People with protected characteristics in particular are not receiving the care they need, when they need it.

Waiting lists: In June 2023, there were over 7 million people on elective care waiting lists. Record numbers are awaiting planned care and treatments. Difficulties in getting GP and dental appointments mean that some are resorting to emergency services or not seeking help until their condition has worsened.

Lack of capacity in adult social care is contributing to delays in hospital discharges, and people are reporting long delays in receiving hospital care. Ongoing staffing and financial pressures in residential and community services are impacting quality of care and increasing the risk of people lacking the care they need.

The State of Care report identifies where people are at greater risk of facing inequalities in terms of access to, and experience of, health and care services.

Ethnic minority groups: Midwives from ethnic minority groups reported that maternity services are affected by racial stereotypes, a lack of cultural awareness, and a culture where racialised discrimination against colleagues is normalised. Ethnic groups are also less likely to be represented in leadership and managerial positions.

People who have a long-term condition from ethnic minority groups said they were talked down to about treatments, were not treated as individuals and reported that a lack of cultural competency was a barrier to receiving good quality care.

Autistic people and people with a learning disability: In supported living services, system failings and a lack of funding mean that budgeting concerns are often prioritised above a truly person-centred approach to support.

People reported that reasonable adjustments, such as communication aids or sensory tools, weren't always used as part of their care.

Successive CQC reports have found barriers in services. Their ‘Out of Sight – who cares?’ report in March 2022 concluded that too many autistic people and people with a learning disability are in hospital and mental health services when they should be receiving care in the community.

The number of autistic people and people with a learning disability in hospitals is still high. At the end of June 2023, there were 2,035 inpatients and over half have been there for over 2 years (1,125).

CQC’s ‘Who I am matters’ report found that needs arising from other protected characteristics, such as age, race and sexual orientation, risked being overshadowed by a person’s learning disability or autism because staff lacked knowledge and understanding about inequalities.

Young People: Last year’s State of Care report highlighted that mental health services were struggling to meet the needs of children and young people.

As a result, CQC have worked with Choice Support and Participation People to develop a Young Champions programme. This means CQC have been able to hear the voices of young people on a regular basis.

LGBTQ+ Communities: CQC highlights the Pride in Practice programme as an example of best practice in healthcare.

The programme supports better access to GP services for LGBTQ+ people. It advises GP practices to revise their policies and language to be more LGBTQ+ inclusive and supports staff in challenging homophobic and transphobic language or actions.

Impact of low income: The State of Care report found that the cost of living crisis has widened and exacerbated existing inequalities in health and social care services.

CQC published guidance in March 2023 for providers with the aim of reducing health inequalities.

Staff mental health is being negatively affected by increasing work pressures, according to people who work in health and social care.

Staff reported that, where mental health and wellbeing is not properly supported, this is having a knock-on effect on the quality of care they deliver.

Maternity services are highlighted in the report as requiring improvement in terms of leadership, staffing and communication. People from ethnic minority groups are particularly impacted by this, due to ingrained inequality in maternity services.

Mental health services are also of concern due to challenges in recruitment and retention of staff.

Artificial Intelligence (AI) has led to innovation and improvements in health and care, with potential to bring greater improvements. CQC recognises the importance of ensuring that these do not entrench existing inequalities.

Mental health: Staff regularly reported that they are overworked and frequently stressed, leading to illness and resignations. Where staff are not receiving adequate mental health support, they say this is negatively affecting their ability to provide safe and effective care.

Pay: Only 26% of NHS reported being satisfied with their pay, which contributed to industrial action during 2023.

Social care workforce: In adult social care, over half of the respondents from providers in England reported problems in recruitment and retention of staff. A significant increase in people arriving to work in the UK from overseas has enhanced diversity and helped resolve staffing issues. But there is also a growing trend of unethical international recruitment practices, with an increasing number of referrals for concerns regarding modern slavery, labour exploitation and international visas.

Problems with the current Deprivation of Liberty Safeguards (DoLS) system are ongoing. As a result, many people who are in vulnerable circumstances are being left without legal protection for long periods of time.

Number of applications to deprive a person of their liberty increased in 2022/23 compared to previous years. The number of applications reached over 300,000, and only 19% of standard applications are being completed within the statutory 21-day timeframe.

These delays mean these challenges are likely to continue.

Integrated Care Systems (ICS) have significantly changed how health and social care works in England.

Local authorities are working to address workforce problems in adult social care. Going forward, they will need to assess paid and unpaid carers’ needs, since there is variation in care across England and many carers are experiencing financial difficulties.

Urgent and emergency care services continue to be reported as ineffective and poor. CQC says that these issues need to be resolved through local systems.