Regulator warns of ‘unfair care’ amid economic strife and staff shortages
A combination of the cost-of-living crisis and workforce pressures risk creating ‘unfair care’, the health and care regulator has warned, with longer waits, reduced access and poorer outcomes for some service users.
The warning came in the Care Quality Commission’s (CQC’s) annual assessment of the state of health and adult social care in England, looking at the quality of care over the past year.
The CQC said that the ‘turbulent’ year had seen the cost-of-living crisis biting harder for the public, staff, and providers, in addition to the ongoing problem of ‘gridlocked’ care highlighted in last year’s report. With workforce pressures also escalating, the CQC warned of the risk of unfair care, where those who can afford to pay for treatment do so and those who can’t face longer waits and reduced access.
Adult social care providers are facing increased running costs, including food and electricity, with some struggling to pay their staff a wage in line with inflation, which affects recruitment and retention. Council budgets have failed to keep pace with rising costs and the increase in the number of people needing care.
The number of people on NHS waiting lists for treatment has grown to record figures and in the face of longer waits, those who can afford it are increasingly turning to private healthcare. The CQC warned this situation was likely to exacerbate existing heath inequalities and increase the risk of a two-tier system of health care, with people who cannot afford to pay waiting longer for care. CQC’s adult inpatient survey, based on feedback from over 63,000 people, found that 41% felt their health deteriorated while they were on a waiting list to be admitted to hospital.
The CQC has continued its focused programme of maternity inspections, with the overarching picture of a service and staff under huge pressure emerging. Ten percent of maternity services are rated as inadequate overall, while 39% are rated as requires improvement. Safety and leadership remain particular areas of concern, with 15% of services rated as inadequate for their safety and 12% rated as inadequate for being well-led.
Women and babies from ethnic minority groups continue to experience higher risks around birth. Infant mortality rates for Black and Asian babies are still higher than for any other group and readmission rates of Black women during the six-week postpartum period continue to rise, and are significantly higher than for women of other ethnicities.
CQC chief executive Ian Trenholm said: ‘The combination of the cost-of-living crisis and workforce challenges risks leading to unfair care, with those who can afford to pay for treatment doing so, and those who can’t facing longer waits and reduced access. And the impact of unresolved industrial action on people can’t be ignored – it’s crucial that both parties work towards an agreement so strikes do not continue into the winter, when disruption will have to be managed alongside increased demand for urgent care and staff sickness.
‘Of course, workforce challenges for the health and social care sector long predate the current industrial action. The publication of the NHS Long Term Workforce plan has been a positive step but implementation will be challenging – particularly without a social care workforce strategy to sit alongside it. We continue to call for a national workforce strategy that raises the status of the adult social care workforce and ensures that career progression, pay and rewards attract and retain the right professional staff in the right numbers.
‘Maternity services and mental health services have been a particular area of inspection focus for us this year, and while we have seen some good practice, we have seen too many examples of poor care, and have taken action to protect people when necessary.
‘However, it’s important to say that we have also seen staff and leaders across all sectors mitigating risks arising from staffing shortages and working hard to deliver good care in very challenging conditions.’
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