Age UK has its voiced its concerns about major inequality in the standards of care for older people after a new report highlighted a worrying variation in the levels of care available to older people.
In a national report, published today, the Care Quality Commission (CQC) has found that over three-quarters of adult social care services are currently rated as Good (77%, 16,351) and 2% (353) are currently rated as Outstanding.
However, it found considerable variation with nearly a fifth (19%, 4,073) of services being rated as Requires Improvement and 2% (343) as Inadequate.
This is the first time that such focused analysis on a national scale has been possible following the formal introduction of CQC’s new regulatory regime for adult social care in October 2014, with expert-led, specialist inspections that focus on what matters most to people using services – are they safe, caring, effective, responsive and well-led? CQC then rates services as Outstanding, Good, Requires Improvement or Inadequate so that the public and providers are clear about its judgements.
Since then, CQC has carried out over 33,000 inspections of around 24,000 different services – many more than once. These include residential homes, nursing homes, care in people’s own homes, Shared Lives schemes and supported living services. These are vital services for thousands of people, young and old, who may be living with a physical disability, learning disability, autism, dementia and/or mental health conditions.
Safety is where CQC has found its greatest concerns, with 23% of services being rated as Requires Improvement and 2% as Inadequate in this key question. Issues uncovered by CQC include ineffective systems and processes for managing medicines or determining staffing levels, which can result in people not getting their prescribed medicines, call bells not being answered, and home visits being rushed or missed.
CQC has used its inspections and ratings to help providers of adult social care understand the specific areas where improvements are needed, to hold them to account to make these necessary changes, to celebrate best practice and to help people to make informed choices about their care.
Already, CQC’s actions are driving improvements in care for people. Of the 686 services that were originally rated as Inadequate and have been re-inspected, more than four in five (81%, 553) improved their overall rating. However, this does still mean that nearly a fifth of services have not improved and further action is required.
CQC has not seen the same rate of improvement in services that were rated as Requires Improvement initially, where only 56% of the services eventually improved to Good, with others failing to improve and some deteriorating.
Worryingly, 26% of the services that were first rated as Good and have been re-inspected have deteriorated. While these are a small proportion of services that were originally rated as Good, it shows that providers cannot always sustain this level of good practice within their services and that, as a whole, the sector continues to be fragile at a time when more people are expected to need its services.
Andrea Sutcliffe, Chief Inspector of Adult Social Care at the Care Quality Commission, said: "When CQC began to transform its regulation of adult social care in England, I asked my staff to consider whether every service they were inspecting was good enough for their Mum or anyone they loved. The ‘Mum Test’ has guided our work ever since and made sure that we always focus on the people who are most important – people who use services, their families and carers.
"Having carried out over 33,000 inspections of around 24,000 different services, most of the adult social care sector is meeting the Mum Test, providing safe and high quality care that we would be happy for anyone we love, or ourselves, to receive. This is thanks to the thousands of dedicated staff and providers who work tirelessly to ensure people’s care is truly person-centred and meets their individual needs.
"However, there is still too much poor care, some providers are failing to improve, and there is even some deterioration."
Caroline Abrahams of Age UK has described this apparent inequality as a ‘Russian roulette’ with older people risking their own safety when finding a care provider. She added: “Taken as a whole, this report is a graphic demonstration of why older people desperately need the Government to follow through on its commitment to consult on proposals for strengthening social care later this year. The report also makes a compelling case for why considerably more investment in social care is required."