CQC's State of Care report finds standards improving but warns of pressures

Author: Sabina Hafesji, senior policy advisor at the NHS Confederation
CQC's State of Care report finds standards improving but warns of pressures
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The State of health care and adult social care in England report is CQC’s comprehensive annual overview of the quality of health and social care in England. It identifies the trends and factors required to enable and sustain high quality care and provides examples of good and outstanding care for others to learn from. Sabina Hafesji, senior policy advisor at the NHS Confederation, summarises its findings.

The CQC found that when people are able to access health and care services, the quality of care received is good. This has been attributed to the hard work of staff who work in these services. But there are cases where people have difficulty in accessing these services, and when left too late, this can have a detrimental effect on people’s care and treatment.

Key points

Integration and collaborative working are a key feature of the report, which shows the travel of direction in line with the NHS Long Term Plan with the commitment for the country to be covered by integrated care systems by 2021.

The report recognises the importance of building relationships and having good leadership to enable systems to have a shared vision. Other areas of common themes for all sectors include workforce challenges and the importance of innovation, and particularly technological advances which can help with improvement in services. This can help with community care but should not come at the expense of human contact. Enablers to innovation includes building good working relationships and empowering staff to lead changes. Cultural changes are required which include working with staff and bringing them together on the journey to better care.

The focus of this year’s report is mental health and learning disabilities, building on themes from last year’s report, and the ongoing work on the thematic review on segregation, seclusion and restraint.

Overall quality in mental health services have remained stable compared to last year, however some specialist inpatient services are struggling in light of serious workforce pressures and high demand.

Safety continues to be the top priority and in particular the need to have specialist staff in hospitals for people with a learning disability and/or autism.  There needs to be continued investment in community services – which is the intention of the NHS Long Term Plan and the Mental Health Act reforms, as well as the community mental health framework that was published recently by NHS England. Specific issues highlighted include staffing, reducing restrictive interventions as well as improving the inpatient estate.

There are continued funding pressures for adult social care, which has not been helped by the lack of a green paper, as well as workforce challenges. Both issues impact people’s ability to be able to access services. Integration between health and social care continues to be a key feature, with the lack of communication and collaboration flagged as a particular obstacle to productive joint working.

There has been a decrease in the number of care homes across the country, whilst domiciliary care provision has increased.

Regarding hospitals in the acute sector and community and ambulance services, as reported in last year’s State of Care report, A&Es continue to struggle to meet unprecedented demand. The majority of services rated in both this sector and community services are rated good, however safety remains an area of concern. Ambulance services have seen some improvement.

The rise in demand has led to more joint working with independent ambulance services. In relation to integrated care, community provision is key. However, more needs to be done about integration in acute services and this will help to meet the demand. One way to do this is to create an open and honest culture to be able to address when things go wrong.

On primary care, overall the quality of services remains high, but access is an issue which can impact people’s experience of care. The report flagged the need for upskilling of staff in this sector to help meet with demand.  


The CQC’s finding that most of the care that it sees across England is of good quality and, overall, the standard is improving slightly is a tribute to the hard work and dedication of all those who work within the NHS.

However, it is recognised that waiting times are increasing and demand for elective and cancer treatments is growing.

We are concerned that twice in 2018 the CQC had to step in over concerns for adult social care providers. Thousands of vulnerable people are being left every day without the care and support they need – this government must seize the opportunity and come forward with proposals that last a generation and more. Failure to deliver a solution will result in further pressure on local hospital and other NHS services. The Health for Care campaign will continue to make the case for a sustainable, long-term settlement for social care.

The report’s emphasis on care services and organisations to work more closely together is the right one and this is the direction of travel signalled by the NHS Long Term Plan. The NHS Confederation is working with system leaders, recognising the importance of building relationships between sectors to help with collaborative working.

However, the government has unfinished business on the NHS. Recently announced funding for NHS building and equipment represents the start and not the end of what is required. Workforce is a particular challenge and the NHS People Plan will not be achieved without additional funding. We would like to see the government commit further funding to this in the upcoming Budget on 6 November.

With the growing pressures on demand and staffing levels, pressures on the provider sector and the system, particular as we enter winter, will be even more challenging. Ensuring the quality and safety of care for people who use services should remain the priority.

This blog was first published on NHS Voices, the NHS Confederation's blog for NHS leaders.