Changing nature of demand spells precarious future for state of care, says CQC

older woman's hands

The Care Quality Commission (CQC) has commended health and social care staff and their leaders for maintaining the quality of care at a time of immense challenge, but warned of an uncertain future for quality as the health and care system ‘strains at the seams’.

Publishing State of care on Tuesday, the regulator's latest annual assessment of health and social care services, the CQC said the quality of care overall is good and improving. 

Analysis of its inspections and ratings found that, as at July 2017, 55 per cent of acute hospital core services were rated ‘good’, as were 68 per cent of NHS mental health core services, and 78 per cent of adult social care services.

But the changing nature of demand – the increasing number of older people who are physically frail, many with dementia, and more people with long-term complex conditions – is placing unprecedented pressure on all sectors, the report concludes. 

Providers’ ability to meet such demand is being pushed to the limits, it says, and challenges of access and funding are starting to take their toll.

The report calls on providers to think beyond organisational boundaries to provide joined-up, person-centred care. This needs to happen with “more consistency and urgency”, with support from national leaders, it says.

Commenting on the publication, Niall Dickson, the head of the NHS Confederation, said: “Let no one misunderstand what is being said here – the health and care system is managing well, with some improvements in safety, but its future is precarious.”

Speaking of the herculean effort of leaders and frontline staff to deliver safe services, he said “it would be a tragedy if the NHS’s 70th birthday was remembered as the year England’s care system collapsed.”


In addition to encouraging signs of progress, State of care found:

  • In hospitals, bed occupancy is at the highest level ever recorded (91.4 per cent between January and March 2017).
  • Deterioration in hospitals’ ability to meet the four-hour emergency access target.
  • Cancer patients are having to wait longer for treatment, with only 81 per cent of the 36,000 being referred for treatment able to access it within two months.
  • Bed occupancy levels in acute admission wards for mental health remain high – 89 per cent in NHS services from January to March 2017.
  • The number of beds in nursing homes has reduced by 4,000 (two per cent) over two years and the volume of local authority funded domiciliary care has decreased.
  • Over three-quarters (78 per cent) of adult social care services were rated as good. However, 19 per cent were rated as requires improvement.
  • The number of GPs per head of population is decreasing.
  • There are major staffing, recruitment and retention issues across the whole of health and social care, which are likely to be compounded by Brexit.
A more detailed summary of the report’s main findings and key messages can be found on the NHS Confederation’s website.

If social care goes down, we all go down

The report acknowledges there is more local services can do to improve coordination and the way services are organised. “The inescapable conclusion has to be that without further government funding today’s perilous state will become tomorrow’s tragedy" said Niall Dickson.

“It is time government and indeed all the political class woke up to this challenge and accept that if social care goes down, we all go down.”

Find out more

Download our slide pack for board members on the main findings of the report. You can also access a more detailed summary from the NHS Confederation’s resources library

View the organisation’s full press statement

Access a range of case studies on the steps Confed members are taking to improve care.

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