The CQC has published its 2024 State of Care Report, providing a nuanced and holistic view of the key challenges faced by the health and social care system in England.

The Care Quality Commission (the “CQC”) has published its 2024 State of Care Report (the “Report”), providing a nuanced and holistic view of the challenges faced by the health and social care system in England. The Report emphasis that “getting the right care, at the right time and in the right place is important for everyone” but the data indicates that people are not accessing the care they need. The Report warns that this is not just a risk for today, but for the future.

Access to care:

The Report highlights that people getting access to care remains a challenge across health and social care services. The Report highlights the following issues:

• GP appointments and NHS dental appointments are the two services which people have most difficulty accessing. The number of people waiting more than two weeks for a GP appointment in March 2024 increased by 18% to five million. The Report also identifies that the number of GPs is not increasing with demand “placing unsustainable pressure on the workforce.” 
• NHS primary dental care is facing a crisis. Patients in areas with low units of dental activity are relying more on private care and for patients who are unable to afford private dental care, ‘DIY’ dentistry is becoming more common.   
• Waits for social care. 45% of delayed discharges for patients who had been in an acute hospital for 14 days or more in April 2024 was due to waits for care home beds and/or home-based care.
• Increasing demand for mental health services. The data highlights a number of key issues including increasing demand on community mental health services, lack of inpatient beds (with bed occupancy increasing to 90.4%) and concerns about the safety of mental health wards.

The CQC has identified this as an area of particular concern in the context of children and young people with 1 in 5 people in this age group being estimated to have a mental health disorder.

• Secondary care remains under pressure. The Report highlights the ongoing demand for secondary care services and that the performance of services to meet the need of care is below the expected standard. For example, as at March 2024 approx. 1.62 million people were waiting for a diagnostic test or procedure.

Areas of concern:

The Report identifies a number of areas which are of specific concern. These include:

• Maternity care. The CQC is concerned that “too many women are still not receiving the high quality maternity care they deserve”. Chronic issues around recruitment and staff retention have been identified as barriers to high quality care.

Concerns about health inequalities also remains pervasive with Black women being more than 2.8 times likely to die during or up to 6 weeks after pregnancy compared to women from white ethnic groups.

• Children and young people’s health. The Report identifies a number of concerns in relation to children and young people accessing the care they need across all health and social care services. The Report highlights that delays can have significant and lasting consequences where treatments and interventions are less effective if not administered at a specific age or developmental stage. 

The Report highlights that the impact of children and young people not accessing the care they require today not only increases their risk of mental and/or physical illness in the future but also their ability to contribute to society. 

• Autism and learning disabilities. Health inequalities for Autistic people and people with a learning disability remains an unacceptable issue. The data identifies that the average wait for an Autism assessment can be up to 328 days for adults and 356 days for children and young people compared to the three month recommendation.

The Report also considered the local system response and based on the data collated as part of the CQC’s pilot of its methodology framework to assess integrated care systems (“ICS”), the CQC identified that finance, joined-up forward planning and workforce depletion are among the main challenges for integrated care boards. Whilst ICS are focused on tackling health inequalities the Report has identified that ICS need to understand the needs of their local population to address the issues for everyone. 

Notwithstanding that the CQC has paused its assessment of ICS for six months, the findings of the Report provide a clear picture of some of the key issues which ICS will need to consider in order to improve outcomes, tackle inequality and better serve their local population. 

If you would like to discuss any of the above please contact a member of our Healthcare team.

This article was written by Lisa Mulholland.