Friday saw the publication of the CQC’s State of Care report, which draws together the evidence available across the whole health and social care sector and seeks to present the key themes that they see emerging. In this blog, we have considered a number of those themes that are of particular relevance to providers in the social care sector.
Increasing numbers of care providers from up and down the country are reporting to us that they are concerned about ambulance waiting times and the impact these are having on those they support and their staff; sadly, in some cases, providers are involved in inquests examining the circumstances around an individual’s death where that individual had to wait a significant period for an ambulance (in some instances the wait time was in excess of ten hours).
The State of Care report documents the factors leading to the delay in ambulance times and covers particular concerns from care home providers that their residents should have the same level of emergency support as others (such as those living in their own homes). What the State of Care report fails to cover, is the practical impact of delays in ambulances on care providers and the challenging situations they are often being left in as a result of the need to ensure the well-being of those they support and their staff during these delays. Clearly, care providers must appropriately monitor those waiting for ambulances and this requires staff resource – where a homecare worker is required to wait for ten-plus hours with someone supported, other staff must cover that care worker’s remaining calls and at a time of staffing shortages across the sector, this can be incredibly difficult to arrange. The State of Care states the problem, but what is lacking is clear practical guidance from the CQC and Department of Health and Social Care to assist care providers in supporting those waiting for an ambulance (recognising the very real challenges being faced by both the care sector and ambulance services). The need for this guidance appears all the more pressing given the upcoming winter period and the associated pressures that this brings.
As expected, the report acknowledges that there are several national issues facing the sector. In particular, it is noted that the health and social care sector continues to feel the repercussions of the Covid-19 pandemic and that recovery is ongoing. The report is also clear that workforce shortages in adult social care are acute, and that this needs to be treated as a national problem with more focus on long-term planning and investment from the Government.
Despite those acknowledgements, many of the inspection reports we have seen this year contain criticism that fundamentally relates to the pandemic and the staffing crisis. For example, criticism may relate to medication errors being made by staff who are under pressure or to the continuity of care because providers cannot retain staff despite their best efforts. Often, there is no reference to wider challenges facing the sector in inspection reports, even though the CQC have expressly acknowledged, in both the 2020/2021 and 2021/2022 reports, that low staffing levels are a national issue.
Many people who use services are unlikely to read the State of Care report. This means that they need the information and the underlying causes of poor-quality care outlined in the State of Care report to be provided in inspection reports. That would help people to make more informed choices about their care and may go some way to promoting public interest and confidence in the sector.
The report highlights that despite the Deprivation of Liberty Safeguards (DoLs) being in force since 2009, many organisations have a lack of understanding of the present regime which risks people being unlawfully deprived of their liberty. There are a number of ongoing issues such as poor-quality Mental Capacity Act assessments, concerns around the knowledge and understanding of staff and a backlog of applications, amplified by the pandemic.
While the report outlines the various concerns in detail, it fails to draw organisations’ attention to the importance of preparing for the Liberty Protection Safeguards (LPS) which are expected to be introduced in early 2023. To avoid a continuation of the current issues under the DoLs scheme, organisations should begin to prepare now to ensure that the principles of the Mental Capacity (Amendment) Act 2019 are well understood by all members of staff and that the correct policies and procedures are in place to safeguard individuals from unlawful deprivation of their liberty. For a more in-depth view of the LPS, see our ebriefing.
The report comes at a time when the work of the Covid-19 public inquiry will also start to review evidence relevant to the care sector. That process is likely to shine a light on many similar challenges faced by providers during the pandemic. However, we hope that it will also present the opportunity to highlight the extraordinary care delivered by so many in the sector.
In adult social care, where workforce shortages are particularly acute, this needs to be treated as a national problem with local solutions.