Regulator’s state of the nation report stays almost silent on safety and quality of adult social care

The care regulator’s annual assessment of “the state of health and care” in England includes almost no discussion of the quality and safety of adult social care services, analysis of the report has revealed.

Large sections of the Care Quality Commission’s State of Care report are devoted to discussion of the quality of care in the NHS, including in mental health services, cancer care, maternity care, dementia care, and services for children.

But there is no analysis or discussion of the safety and quality of a wide sweep of long-term adult social care services, such as home care and residential home provision, other than a small section that praises the work of the minority of “outstanding providers”.

A Care Quality Commission (CQC) press release says the report is supposed to look at “the quality of care over the past year”, but at no point in the 180-page report does CQC discuss the overall quality and safety of adult social care services in England, even though it should have access to that information through its programme of inspections.

Instead, the report’s adult social care section focuses on the number of requests for council support, the number of people waiting for care services, the number of delayed discharges, staff vacancies, recruitment of care staff, and bed occupancy rates in care homes.

In the report’s appendix, there are two tables which provide figures for how adult social care services were rated, but there is no comparison with previous years.

The report does discuss the safety and quality of intermediate care – short-term services usually provided by a mix of health and social care professionals.

And there is a section on “restrictive practice” in services for autistic people and people with learning difficulties, which includes concerns about the inappropriate use of chemical restraint and about “closed cultures” where staff do not speak up about abuse.

The report says that CQC analysis of information provided by care homes found that in settings where more than half of residents were recorded as autistic or having learning difficulties, the incidence of restraint was on average nearly 12 times higher than in care homes where nobody was recorded as being autistic or having learning difficulties.

Earlier this month, a review ordered by the last government found “significant failings” within the CQC.

The review of the effectiveness of the commission found an “urgent need” for a rapid turnaround in the way it operates, with the proportion of health and care settings that had never received a rating rising from 13 per cent to 19 per cent over the last five years.

The State of Care report found that, in 2022-23, the number of new requests for council-funded adult social care support that did not result in a service being provided had increased by 27 per cent since 2017-18.

And it said that people in black or black British ethnic groups were over three-and-a-half times more likely to be detained under the Mental Health Act than people in white ethnic groups.

The report also raised concerns over the increasing number of people who need the protection provided by the Deprivation of Liberty Safeguards (DoLS) system.

The safeguards were introduced nearly 20 years ago and were designed to protect the human rights of adults in care homes and hospitals who do not have the capacity to consent to their care arrangements and need to be deprived of their liberty.

The report says: “Too many people are waiting too long for a DoLS authorisation, while variation in the level of knowledge of staff means that others may not have a DoLS authorisation in place when they need one.

“For many, the current DoLS system is not providing the vital safeguards they need.

“After a decade of chronic and widely documented issues, urgent action is required to ensure the system does not continue to fail people in the future.”

In response to concerns raised by Disability News Service about the report, a CQC spokesperson said: “This year our State of Care report focuses on the urgent issues facing care services for children.

“The report builds upon findings from previous years’ reports of which adult social care was a main focus.

“On adult social care we draw attention to the fragility of the sector, highlighting the delays in local authority support and the impact this can have on care.

“The report includes experiences of those living with and supporting people with dementia, as well as the impact workforce pressures are having on the sector.

“We also highlight significant concerns in the care provided to those with learning disability and autism, emphasising inadequate support, and the need for improved safety and quality of services.

“We continue to closely monitor adult social care services and the level of care being provided.”

The commission said it was working to improve and develop its approach to assessments, and was unable to compare ratings with previous years as they are in a transition period.

Picture by Andrew Parsons/No 10 Downing Street 

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