The Care Quality Commission ('CQC') has published its annual report for 2019/20. The report looks at four key areas: the quality of care before the COVID-19 pandemic; the impact of the pandemic; collaboration between providers and the challenges and opportunities which lie ahead. 

The report has found that the quality of care people in England receive remains good overall, but that there has been no improvement since the 2018 report was published.

Quality of Care Before the Pandemic

The report reiterates findings from 2017 and 2018, namely that there is a disparity in care standards and access to care across the country. A lack of coordination between government, Parliament and local authorities is contributing to this disparity. The messages in the 2019/20 report are similar to previous iterations in this regard, an emphasis is placed on community and working together in order to improve care standards and access to good quality care.

The main risk areas are found in the types of care that are harder to plan for, such as maternity and emergency care services. 41 per cent of the former and 44 per cent of the latter services were marked as requiring improvement in this year’s report. Some of the poorest quality services are finding it most difficult to improve. A number of GP services, care homes, and NHS trusts have consistently been marked as inadequate and have shown no signs of improvement.

Access to mental health services has previously been highlighted as an area of difficulty and improvement in this regard has been described as 'limited'. A lack of availability of community crisis services left some individuals forced to attend emergency departments, which often lacked suitable safe and therapeutic environments.

The Impact of the COVID-19 Pandemic

The COVID-19 pandemic continues to place an enormous strain on the entirety of the health and care system. Care service providers have had to introduce novel ways of maintaining care services for the most vulnerable people in society, whilst ensuring that COVID-19 transmission is reduced to the greatest extent possible.

All aspects of the health and care system have been impacted and forced to adapt. The number of referrals for treatment dropped by over one million between February and April, while waiting times for treatment increased dramatically. Hospital and care staff have worked long hours in difficult circumstances to try and maintain care standards and have showed unparalleled resilience. All services have had to alter working practices to incorporate PPE and COVID-19 safety procedures. . Some mental health services have provided digital devices so that patients are able to maintain contact with their family and friends, and this is just one example of creative ideas that have been introduced to keep people together.

The COVID-19 pandemic has impacted some groups of people disproportionately. The report highlights that the proportion of deaths in all adult social care services due to confirmed or suspected COVID-19 was higher for Black (49 per cent) and Asian (42 per cent) people compared with White (41%) and people from mixed or multiple ethnic groups (42 per cent). The report states the need for this knowledge to be utilised in the future, to ensure fair access to equitable care.

The COVID-19 pandemic has accelerated innovation, which can improve both the quality of care received and access to care services. The lessons learned and innovations adopted throughout the COVID-19 pandemic should be used to inform health and social care developments in the future.

Collaboration Between Providers

It was flagged in the 2018 report that collaboration between services was one of the key areas in which health and care services could be improved. It is acknowledged in the latest report that different parts of the country are at different stages of this improvement effort.

The report highlights significant differences in how certain regions dealt with the pandemic, which was largely dependent on pre-existing relationships between regional systems. Those regions with strong links between health and social care providers benefited from better communication and more coherent responses to the pandemic, in particular when the messages at a national level were at times confusing or even contradictory.

New recruitment and staffing methodologies were adopted across the health and care sector, to ensure that there was adequate staffing in a time of greatly increased demand for services. Ensuring staff safety remains of paramount importance. The reports shines a light on some significant challenges faced by the sector, such as a global shortage of PPE and the risk of transmission between health and care workers and their families. Again, at a time when the strain on the health and care workforce has never been greater, the State of Care Report praises the resilience of staff.

The use of technology played an important role in the response to the pandemic this year, but its introduction and adoption was not seamless. Not all services had the hardware, or online presence to make use of technological advances. Care homes and dentists practices often lacked the equipment to enable online consultations and certain types of care will never be suited to online or remote care. Generally speaking however, the enhanced use of technology has helped people to access care during the pandemic, which should be seen as a positive.

Looking forward, the challenges and opportunities ahead

It is clear from the report that the issues which persisted prior to the pandemic still require attention. While it is perhaps understandable that standards of care have not improved in a year when the health and care system has been ravaged by a pandemic, when life does return to normal there will be problems requiring urgent attention.

The waiting lists for urgent and elective care need to be addressed. Those people who require urgent care also need to be kept safe while they wait for treatment.

The efforts of staff in the health and care workforce must be recognised, according to the CQC. A new deal should be reached, which prioritises career progression, shows staff that they are valued and invests in their training. 

The COVID-19 pandemic has forced change, and a lot of the changes which have been adopted are inherently positive. This progression, and the positive lessons learned, should be used to inform a way of working which is supported at all levels across the health and care sector.

If you would like to discuss anything contained in the State of Care Report 2019/20, please contact Paul Doherty, Ceri Barrett, Jonathan Eves, Patrick Parkin or your usual Burges Salmon contact.

Article written with the assistance of Harrison Folland.