The CQC has published its State of Care Report for 2022, offering a nuanced and data rich picture of the health and social care system. Themes from recent years continue: staffing pressures, lack of access to services and the legacy of the COVID-19 pandemic. However, data shows that these challenges are more urgent than ever - the report explains that in many cases patients are no longer able to access the services that they need.
The challenge: a system in gridlock
The Report opens, "in 2022, the health and care system is gridlocked, unable to operate effectively."
Three data points illustrate the issue:
- Ambulance queues: Ambulance crews aim to handover each patient in 15 minutes or less, with nobody having to wait more than 30 minutes. In March 2021, there were 7,000 handovers taking over 60 minutes. In March 2022, there were more than 45,000.
- Discharge from hospital: In July 2022, only 4 out of 10 patients were able to leave hospital when fit to do so as they awaited a care package. Extreme workforce shortages in the adult social care sector make timely discharge impossible. 99% of healthcare leaders surveyed in July 2022 agreed that there was a social care workforce crisis in their area.
- Lack of access to primary care increases pressure on hospitals: lack of GP and dental appointments meant that NHS 111 could not always appropriately signpost people to primary care, instead directing people to call 999 or present at A&E. 91% of NHS dental practices are no longer accepting new patients. Lack of access is not attributable to reduced output - general practice is busier than ever: the number of general practice appointments during the winter of 2021/2022 was the highest ever recorded.
The report celebrates that despite immense pressure, once access issues are surmounted, the quality of care provided is overwhelmingly good. In 2022:
- 83% of adult social care services were rated as good or outstanding
- 96% of GP practices were rated as good or outstanding
- 75% of NHS acute core services were rated as good or outstanding
- 77% of all mental health core services (NHS and independent) were rated as good or outstanding.
However, the report highlighted specific failings, including:
- Unacceptable inequalities in access to care;
- Poor provision of care for those with disabilities and autism; and
- Urgent failures in NHS maternity services – 6% of NHS maternity services are rated as inadequate, with 32% requiring improvement.
Patient satisfaction
Despite the CQC reporting demonstrating that the quality of services is predominantly good, survey data shows that dissatisfaction is growing: amongst patients and staff.
- Results from the British Social Attitudes survey published in March 2022 show the proportion of people satisfied with the NHS overall dropping from 53% to 36%. More people (41%) were dissatisfied with the NHS than satisfied.
- Satisfaction with every type of service was down:
- GP services from 68% to 38% (the lowest since the survey began in 1983)
- inpatient services from 64% to 41%
- A&E services from 54% to 39%
- NHS dentistry services from 60% to 33% (again, the lowest since the survey started).
- As for social care, based on 2021 data, only 15% of respondents were satisfied with social care services and 50% were dissatisfied.
Dissatisfied patients are increasingly turning to pay for treatment. From April to June 2019, 50,000 people opted to self-fund private treatment. During the same months in 2021, this number had risen by 30% to 65,000.
Exhausted staff continue to feel the strain. In 2021 survey data, only 43% of staff surveyed said they could meet all the conflicting demands on their time at work, a 5-year low. Staff 'felt the impact of the pandemic considerably, which has manifested itself in stress, burn-out and staff leaving the profession.' Vacancy rates are the highest they have been for 5 years, and retaining staff is as challenging as recruitment. A survey carried out by the Royal College of General Practitioners indicated that 42% of GPs plan to quit the profession within the next 5 years, and that despite the current training pipeline this will result in a net reduction in the GP workforce.
The future
- New legal foundations: The Health and Care Act 2022 heralds a new legal basis for the delivery of health and social care in England, introducing Integrated Care Systems which seek to provide leaders and communities with a platform to collaborate and innovate as they respond to today's challenges.
- Valuing people: The report celebrates everything that the people who work in the NHS and care sectors do for their communities. So many of the privileges that we enjoy in the UK depend upon the skill, experience and dedication of our health and social care staff. The Report praises initiatives that have provided short-term solutions to tackle the recruitment and retention crises by maintaining morale and wellbeing during the pandemic. However, the CQC emphasises that long-term changes are needed: the care sector requires investment so that it is able to establish career pathways that offers staff and job seekers a future.
- Using data: The Report emphasises the role that effective use of data has to play in tackling health inequalities and making the best use of staff and services. Improved sharing of better demographic data between services can be used to ensure that the right care is targeted at the right people.
Article written by Patrick Parkin with assistance from Isabel Robinson & Sam Charkham.