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The state of health care and adult social care in England 2015-2016

The state of health care and adult social care in England 2015/16

This annual overview of health and social care in England looks at the trends, highlights examples of good and outstanding care, and identifies factors that maintain high-quality care.

The CQC’S inspections have found that many health and care services in England are providing good quality care despite a challenging environment, but that substantial variation remains.

Around three-quarters of NHS services, care homes, general practices and other services that had been rated as ‘inadequate’ were able to improve their ratings following re-inspection.

But although some health and care services are improving, they are also starting to see some services that are failing to improve and some deterioration in quality.

State of Care finds that the sustainability of the adult social care market is approaching a tipping point. This view is based on the evidence of inspections, information received through their market oversight function, and external data.

The fragility of the adult social care market is now beginning to impact both on the people who rely on these services and on the performance of NHS care. The combination of a growing and ageing population, more people with long-term conditions, and a challenging economic climate means greater demand on services and more problems for people in accessing care.

This is translating to increased A&E attendances, emergency admissions and delays to people leaving hospital, which in turn is affecting the ability of a growing number of trusts to meet their performance and financial targets.


Key findings

  • The quality of care still varies considerably, both within and between different services. CQC rated a minority of services as inadequate: 2% of adult social care services, 3% of GP practices and 5% of hospital core services as at 31 July 2016.
  • It is a time of unprecedented demand and financial challenge for health and social care, driven by the growing numbers of older people in need of care and support, and those with complex health and care needs. By the end of 2015/16, NHS providers had overspent their budgets by £2.45 billion. Local authorities were reported to have spent £168 million more than they budgeted for, often drawing on their reserves to do so
  • About three-quarters (76%) of those that were re-inspected following an initial rating of inadequate achieved an improved rating: 23% went from inadequate to good and 53% went from inadequate to requires improvement.
  • Almost half (47%) of those services that were re-inspected following a rating of requires improvement did not change their rating. In 8% of cases, the quality of care deteriorated so much that the CQC rated it inadequate.
  • Strong, visible leadership continues to be a major factor in delivering and sustaining high quality services, and in making improvements.
  • The best providers often had a stronger drive to improve, were focused on how to make services better for people, and were committed to collaborating with others to achieve this.
  • On the whole, public opinion of health and care is positive. Around three-quarters (74%) of people agreed that local NHS services in general were good. Almost two-thirds (62%) of people receiving adult social care services paid for by their local authority said they were extremely or very satisfied with their care and support.
  • Between a quarter and a third were not satisfied with their care, and there are no equivalent surveys to capture the views of people who pay for their own social care, or of those who have to rely on their families or informal care arrangements
  • Many care homes, home care agencies and other adult social care services are providing good quality care (71% rated good and 1% rated outstanding).
  • Of those services rated inadequate that were re-inspected, more than three-quarters (399 out of 520 initially rated inadequate) had improved enough to receive a higher rating. This means that nearly a quarter of these re-inspected services did not improve.
  • Half of services rated as requires improvement that were re-inspected (904 out of 1,850) had no change to their rating. In 153 cases (8%), the CQC found that the care had become inadequate.
  • Until recently, the growth in demand for care for people with greater care needs had been met by a rise in the number of nursing home beds. However, this bed growth has come to a halt in the last 16 months.
  • The CQC have seen profit margins reducing – both due to pressures on fees that funders of care are able or willing to pay, and cost pressures that include the impact of the national living wage.
  • There were examples of large providers starting to hand back home care contracts that they think are uneconomic and undeliverable.
  • While so far the sector has been more resilient than some anticipated, the CQC are concerned about the fragility of adult social care and the sustainability of quality.
  • This is concerning for the continuity and quality of care of people using those services, and for the knock-on effects across the whole health and care system: more emergency admissions in A&E, more delays for people ready to leave hospital, and more pressure on other services