Healthcare delivery
The State of Care: are we delivering ‘unfair care’?
The Care Quality Commission’s (CQC’s) annual ‘State of Care’ report has warned that a combination of the cost-of-living crisis and workforce pressures is risking ‘unfair care’ – with some able to afford to pay for treatment, while others are facing longer waits, reduced access, and poorer outcomes. CSJ shares an overview of the key findings.
In its latest State of Care report,1 the CQC
commented that it has been ‘a turbulent year’ for health and social care. In addition to the ongoing problem of ‘gridlocked’ care highlighted in last year’s ‘State of Care’ report, the cost-of- living crisis is biting harder for the public, staff, and providers – and workforce pressures have escalated. Ratings data shows a mixed picture of quality, with a notable decline in maternity, mental health and ambulance services. The report points out that workforce
challenges have intensified, with unresolved industrial action by NHS staff unhappy with pay and conditions. The number of people on waiting lists for treatment has grown to record figures and in the face of longer waits, those who can afford it are increasingly turning to private healthcare. Research by YouGov shows that 8 in 10 of those who used private healthcare last year
would previously have used the NHS, with separate research showing that 56% of people had tried to use the NHS before using private healthcare. This situation is likely to exacerbate existing heath inequalities and increase the risk of a two-tier system of healthcare, with people who cannot afford to pay waiting longer for care. CQC’s adult inpatient survey, based on feedback from over 63,000 people, found that 41% felt their health deteriorated while they were on a waiting list to be admitted to hospital. People may also be forced to make difficult
financial choices; CQC heard from someone in receipt of benefits who resorted to extracting their own tooth because they were unable to find an NHS dentist. They then had to pay £1,200 on a credit card for private treatment, doing without household essentials until the debt was paid. Key findings of the report include:
l Getting access to services remains a fundamental problem, particularly for people with protected equality characteristics. Along the health and care journey, people are struggling to get the care they need when they need it.
l Record numbers of people are waiting for planned care and treatment, with over 7 million people on elective care waiting lists at June 2023. But the true number of people could be much higher, as some people who need treatment are struggling to get a referral from their GP.
l In the community, people are facing ongoing struggles with getting GP and dental appointments. As a result, some people are using urgent and emergency care services as the first point of contact, or not seeking help until their condition has worsened.
l Once at hospital, people are facing longer delays in getting the care they need. In 2022, over half (51%) of respondents to our urgent and emergency care survey said they waited more than an hour before being examined by a nurse or doctor, up from 28% in 2020.
l Insufficient capacity in adult social care is continuing to contribute to delays in discharging people from hospital. Ongoing staffing and financial pressures in residential and community services are having an impact on the quality of people’s care, with some at greater risk of not receiving the care they need.
Referrals for cancer treatment In last year’s State of Care report,2
CQC
highlighted its concerns around the length of time people were waiting for elective care and cancer treatment from NHS services, with people living in the worst performing areas more than twice as likely to wait more than 18 weeks for treatment as people living in the best performing areas. In a bid to address lengthy wait times, NHS England introduced a new target called
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