Almost half (49%) of adult care services rated ‘requires improvement’ by the Care Quality Commission failed to achieve a higher rating at re-inspection, the watchdog has said.

A further 8% of services had deteriorated and were downgraded to an ‘inadequate’ rating.

The findings come from the CQC’s annual report on the state of health and care services in England. Of the 1850 services re-inspected in 2015-16, 904 had no change to their ‘requires improvement’ rating, 153 became ‘inadequate’, and the remaining 793 were able to improve.

Improvements were more widespread for ‘inadequate’ services, with 76% achieving a higher rating at re-inspection (23% jumped from ‘inadequate’ to ‘good’).

Speaking at the launch of the report, CQC chief David Behan, said: “It is hard to improve services that are struggling. It is not just about money – it is about good leadership, collaborating with others, and the ability to learn when things go wrong. In the services we re-inspected in adult social care, some of those characteristics weren’t there.”

‘Flagging the risk’

Behan added that the failure of services to make improvements quickly enough was one of five factors that suggested the adult social care market was “approaching a tipping point”.

The other four factors, which are supported by evidence from the CQC’s inspections and market oversight data, as well as a variety of external sources, are:

• Residential and domiciliary care services are starting to hand back “undeliverable” contracts to local authorities due to cost pressures.
• The steady increase in nursing home beds – from 205,000 beds in 2009 to 224,000 in March 2015, has now stalled, with numbers remaining static since that time.
• The increase in the number of people living with unmet social care needs – Age UK estimates this has risen from 800,000 in 2010 to over a million in 2015.
• The decline in the numbers of older people receiving local authority-funded social care, which has fallen by 26% since 2009.

Behan said: “I have worked in health and social care for 38 years and I cannot recall a time where those five factors have occurred together.

“We do not know when this tipping point is going to happen but if we did not flag this risk to sustainability in the future we would be failing in our responsibilities.”

The fragility of the adult social care system is also now beginning to impact on the performance of NHS care, the report warned. It said the increase in A&E attendances, emergency admissions, and delayed discharges were all directly linked to social care pressures.

Behan added: “While there are no easy answers or quick fixes, what distinguishes many of the good and outstanding services is the way they work with others – hospitals working with GPs; GPs working with social care, and all providers working with people who use services.

“Unless the health and social care system finds a better way to work together, I have no doubt that next year there will be more unmet need, less improvement and more deterioration.”

‘Poor safety and leadership’

The CQC had inspected more than 16,000 care services by 31 July 2016. Of these, 71% were rated ‘good’, 1% ‘outstanding’, 26% ‘requires improvement’ and 2% ‘inadequate’.

Services continued to perform best at being ‘caring’, with nine out of 10 providers receiving a ‘good’ or ‘outstanding’ rating for this area of the regulator’s inspection criteria.

Ratings for safety and leadership were comparatively lower, with 3% of services rated ‘inadequate’ for safety and 3% receiving an ‘inadequate’ rating for leadership.

The report said these low ratings were “concerning” and had resulted in people not getting the right medicine or staff not having time to care for people properly. It highlighted the prosecution of a care home owner and its former manager in September 2016, who were fined £50,000 after admitting they failed to provide safe care. Behan said at the report launch that the watchdog was in the process of bringing a further 14 prosecutions against care services.

‘Brexit uncertainty’

The report flagged the ongoing recruitment and retention issues in the sector and pointed to the uncertainty surrounding the status of EU workers – who make up an estimated 7% of the adult social care workforce – and to the extent they will be affected by the UK’s vote to leave the European Union. The recruitment of nurses remains a “significant concern”, it said.

Margaret Willcox, vice-president of the Association of Directors of Adult Social Services, said: “We have been arguing for some time now that adult social care needs to be given adequate recognition and resourcing.

“Services are being cut and the outlook for future care is bleak. We are at a tipping point where social care is in jeopardy and unless the government addresses the underfunding of the sector, there will be worrying consequences for the care market, the NHS and, most importantly, for older and disabled people, their families and carers.”

A Department of Health spokesperson said that the report showed that most NHS services, social care providers and GP practices inspected by the CQC were rated ‘good’ or better and “improvement is taking place all over the country”.

“The government is investing £10 billion to fund [the NHS’s[ own plan for the future, and crucially is ensuring that the amount of money available to local authorities for social care is rising in future years of the parliament, reaching up to £3.5 billion extra by 2020.”