15 November 2019

CQC has recently published its annual State of Care report. The report finds that the quality of care provided in England has continued to improve steadily over the past 12 month. Despite the reported quality improvement, funding pressure and workforce challenges continue to be identified as significant barriers to effective access of services. In particular, adequate access to mental health services has been found to be an area of particular challenge. Health and social care providers are also encouraged to focus on how implementation of technology can further enhance care delivery. 

In the last year, CQC has twice exercised its legal duty to notify local authorities when they believe there is a real and credible risk of service disruption due to provider business failure. These are the first notifications of their type to be made during four years of the CQC Market Oversight scheme – and include the well-publicised notification in relation to Allied Healthcare. This notification came to light (at least publically) in the past 12 months, although it is known that the CQC had been in the early stages of that process for some time before this year. It is not possible to be certain as to whether CQC intervention has actually helped to prevent service failure in these instances.

Key findings

Quality improvements

80% of adult social care services are rated as “good”. Compared with last year, an additional 282 services are providing “outstanding” care. The percentage of “good” or “outstanding” services has increased across every region of the country and there is now less variation in quality between the regions.

Technology and innovation should be better utilised

The report set out CQC’s view of the five main barriers to the adoption of technology in social care:

  • a lack of funding to invest in new technology and difficulties in making economic returns, particularly for smaller service providers
  • a low level of knowledge and awareness of new technology among service providers and their staff
  • concerns that technology could interfere with the importance of personal support within the sector
  • the general perception that people who use adult social care services are not interested or will respond negatively to technology, and
  • concerns about the ethical and data protection implications of adopting technology.

Despite these barriers, CQC states that it has seen a range of technologies being used to deliver care more effectively and to help individuals get a better experience of care. CQC believe that there is still much more to be done in this area and that they have not seen enough examples of joined-up thinking between commissioners and providers where new technology could be central to improving the quality of care for individuals.

Funding pressure and workforce challenges continue to effect access to services

Funding pressure and workforce challenges are identified as two significant barriers to effective service access. Again, this is nothing new. Funding pressure continues to be a huge strain on the sector. 65% of adult social services directors are not confident that their budgets will be sufficient to meet specific statutory duties in 2019/20. Many individuals funded by local authorities are missing the support of some care services because the contracts for these providers do not cover the true cost of delivering care for these individuals. Pressure on funding also puts investment in tech, and the consequent improvements in care quality, at risk. Care continues to be a comparatively slow adopter of tech to other sectors.

Workforce challenges include a shortage of qualified nursing staff, a lack of registered managers, high staff turnover and high vacancy rates. These issues are severely limiting the care that some service providers are able to offer and the trend of figures over recent years demonstrate that workforce challenges are worsening.

The result of these major challenges is that access to care continues to vary across the regions – there is a clear need for the urgent formulation of a robust and forward thinking funding plan to improve nationwide access to services in the future.

The Implications of Brexit

Whilst Brexit and the imminent General Election dominate the current political landscape, it is understandable that consideration of crucial health and social care policies is not at the top of the Parliamentary agenda. Parliament must strive to find the time to discuss the potentially controversial policies that are required to enforce positive change.


A positive message from the report is that despite the clear challenges faced by the sector, the majority of services have improved in terms of quality – at least in terms of the CQC’s own inspections. The failure to find agreement on a future funding model continues to create (or rather, maintain) levels of uncertainty in the sector, and there is continued pressure on Parliament to rectify this by formulating a long-term and sustainable funding plan. Certainty over funding will hopefully unlock tech investment – where that can be targeted to improve the quality of care (acknowledging that tech for tech’s sake is not the answer).

CQC has recommended closer collaboration between service providers at a local and national level to improve the overall quality of care provided. They have also emphasised the requirement for public sector support to facilitate the necessary improvements. CQC’s repeated encouragement of increased collaboration is a logical one, but there is work to be done to ensure that adequate frameworks are in place to enable providers to work collaboratively in an efficient manner.

If you have any queries in relation to this article, please contact Paul Doherty, Patrick Parkin or your usual Burges Salmon contact.

This article was written with the support of Tom Needham (trainee solicitor).

Key contact

Paul Doherty

Paul Doherty Director

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