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State of Care 2016 – inspection outcomes and improving quality

As part of the release of the CQC's State of Care Report 2015-2016, we have produced a series of articles highlighting the findings and our analyses. Here, Holly Bontoft gives an overview of the outcomes and trends of the inspections over the past year.

As part of the release of the CQC's State of Care Report 2015-2016, we have produced a series of articles highlighting the findings and our analyses.  Here, Holly Bontoft gives an overview of the outcomes and trends of the inspections over the past year. 

CQC began producing the State of Care reports last year, when its new inspection process had not been fully rolled out.  Now almost all providers have been inspected, and where problems were found the first time many have had follow up inspections.  This year's report therefore gives a much better understanding of the true state of care.

The good news is that 71% of adult social care providers were rated as 'good', with another 1% found to be 'outstanding'.  In particular, 21% of hospices were rated as 'outstanding', although figures were somewhat lower for residential and nursing homes.  Of particular concern is that 37% of nursing homes were found to 'require improvement', and 4% were found to be 'inadequate'.  Furthermore, 44% of NHS acute hospitals were rated as either 'inadequate' or 'requiring improvement'.

The most interesting figures are for those services that have now been inspected twice, most often because of a 'requires improvement' or 'inadequate' rating at their first inspection.  One overall finding is that adult social care services are capable of maintaining quality, but the sector is rapidly approaching a tipping point that will challenge its sustainability.  Of the adult social care services that had been re-inspected after a previous 'inadequate' rating, 77% improved sufficiently to get a higher rating.  However, of those that originally received a 'requires improvement' rating, half received the same rating again and 8% actually had their rating drop to 'inadequate'. This could be an indicator of those who have had the resources to invest in a turnaround project compared to those who have, for whatever reason, been unable to make the necessary investment from both a time and financial perspective. When a home is placed into "special measures", the viability of the business is seriously threatened given the increased regulatory involvement and the reassurance sought by commissioners, as well as the obvious adverse publicity. The ability of the registered manager to undertake their day to day responsibilities becomes compromised with the additional workload of improving services, which is why those with capacity to provide additional management assistance are in a much better position to improve rapidly.

The particular concern in the report is that the increased financial pressure on the care sector, through increasing staffing and other costs despite decreasing local authority funding, has meant that the number of beds available is not growing, despite an increasing need for them.  The clear message from the CQC is that this pressure on costs will in turn affect the sustainability of quality in the sector, particularly in relation to nursing care.  Financial stability is key not only to the sustainability of existing quality, but also to improving where it has previously been found lacking.  A poor rating runs the risk of placing increasing financial pressure on a care home at the exact point when it needs further funding to improve.

One partial glimmer of hope was that the proportion of adult social care services being rated 'inadequate' decreased from 7% to 2%.  However, the CQC acknowledges that this is at least partially due to the first inspections being targeted towards services where there were concerns, and due to homes improving after an originally poor inspection.  The start of the new inspection scheme may also have caused a shock to the system, prompting other services to get their act together in anticipation for their own first inspection under the new system. This year will bring increasing challenges for those investing and operating in the sector as the CQC starts to look more to the ownership structure and financial position of the operator as part of their inspection of the leadership of a service. Their powers of financial oversight has been around for over two years in relation to the large operators, and in our view, this will become more prominent in the general inspection regime. The ethos and ownership structure is already governed by the fit and proper requirements.

What is increasingly evident is that, despite greater demand for beds than ever, the care sector is going to struggle to meet the various pressures on it.  CQC is clearly alive to these concerns and there appears to be a political message highlighting this now, perhaps in anticipation of adverse events in the future.

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