The care watchdog has raised a series of concerns about access to care and support, the over-use of restraint and seclusion, and the failure to provide legal protection to disabled people in vulnerable situations, in an annual report.
In its annual assessment of the state of health and adult social care in England, the Care Quality Commission (CQC) warned that a combination of the cost-of-living crisis and pressures on the health and care workforce risked “longer waits, reduced access and poorer outcomes for some”.
In its State of Care report, the commission warns that local authority budgets have “failed to keep pace with rising costs and the increase in the number of people needing care”.
This has led to the risk that people who live in more deprived areas “may not be able to get the care they need”, it says.
And it says that some disabled people who pay for their own care at home have had to cut back on support as providers have increased their fees.
The report also raises concerns that staffing shortages in the mental health sector have led to “the over-use of restrictive practices, including restraint, seclusion, and segregation”.
There is also an analysis of the continuing problems with the Deprivation of Liberty (DoL) system of human rights safeguards.
Care homes and hospitals should apply DoLs when an adult does not have the mental capacity to consent to their care arrangements and they need to be deprived of their liberty through “supervision and control”, but this should only happen when “necessary, proportionate and in the person’s best interests”.
CQC said it was concerned that the DoLs system was unable to cope with the demand for assessments, with the number of applications to deprive a person of their liberty increasing to over 300,000 in 2022-23, with only one-fifth of standard applications completed within the statutory 21-day timeframe.
DoLs were supposed to be replaced by the new Liberty Protection Safeguard (LPS) system in October 2020, but the government said in April that their implementation would be delayed “beyond the life of this Parliament”.
The report says: “We are concerned about what this means for people being potentially deprived of their liberty unlawfully, for their family and friends, and for providers and local authorities.
“Disabled people and older people are more likely to require the safeguards offered by DoLs and will therefore be disproportionately affected by the decision to delay LPS.”
The report says CQC is concerned that the problems with DoLs are contributing to the overuse of “restrictive practices”, with its expert advisory group warning that some adult social care providers “continue to use stricter measures introduced during the pandemic without recognising them as potential human rights infringements”.
The report also says that NHS England data shows the number of new requests to councils for adult social care support increased by three per cent between 2020-21 and 2021-22 to reach nearly two million requests.
But more than half a million of these requests (568,685) did not result in extra support, an increase of more than four per cent, while another 522,850 received only universal services (those available to anyone, without the need for an assessment) or were advised to contact non-council services, such as local charities.
Since 2017-18, the rate of new requests granted through either short- or long-term care has fallen by more than two per cent, from 915 to 895 per 100,000 population aged 18 and over.
Meanwhile, the rate of requests from working-age adults per 100,000 population has increased by 15 per cent over the last five years, while in 2021-22 more than 205,000 adults aged 18 to 64 were not provided with adult social care support when they requested it.
Mikey Erhardt, from Disability Rights UK, said: “The latest Care Quality Commission report is a damning indictment of our failing system.
“Disabled people across the country are being failed by a system that simply does not care.
“This report must be a red line, which breaks the current cross-party consensus on cuts, and spurs the change we all need to experience.”
The Department of Health and Social Care (DHSC) said this week that it had made up to £8.1 billion available in additional funding to support adult social care over the next two years, which it claims will put the system on a stronger financial footing and help local authorities address waiting-lists, low fee rates, and workforce pressures.
The CQC report also warns that people with learning difficulties and autistic people “continue to be in hospital inappropriately when they should be receiving care in the community”.
At the end of September 2023, there were 2,045 such inpatients, and more than half of them (1,115) had been there for more than two years*.
But this is a drop of less than 200 on the 2,240 inpatients there were at the end of March 2022 – 18 months ago – whereas the government’s target is to cut the number of people with learning difficulties and autistic people in specialist inpatient care by 50 per cent by March 2024 compared with March 2015, when there were 2,900.
A DHSC spokesperson said: “We remain committed to achieving our ambition set out in the NHS Long Term Plan to reduce by half the number of autistic people and people with a learning disability in mental health hospitals, by March 2024, through investment in community support.
“This year, we are investing an additional £121 million to improve community support, including funding for children and young people’s keyworkers.
“The number of people with a learning disability and autistic people in specialist mental health inpatient settings at the end of September 2023 was 2,045 – a 30 per cent net reduction since March 2015.”
*These are more up-to-date figures than those in the CQC report, as new figures were released by NHS Digital last week
Picture by Andrew Parsons/No 10 Downing Street
A note from the editor:
Please consider making a voluntary financial contribution to support the work of DNS and allow it to continue producing independent, carefully-researched news stories that focus on the lives and rights of disabled people and their user-led organisations.
Please do not contribute if you cannot afford to do so, and please note that DNS is not a charity. It is run and owned by disabled journalist John Pring and has been from its launch in April 2009.
Thank you for anything you can do to support the work of DNS…