Healthcare delivery
risks around birth. Infant mortality rates for Black and Asian babies are still higher than for any other group and readmission rates of Black women during the six-week postpartum period continue to rise and are significantly higher than for women of other ethnicities. Alongside its programme of maternity inspections, CQC commissioned a series of interviews with midwives from ethnic minority groups to explore their experiences of working in maternity services and their insights into safety issues. A common theme from these interviews was that care for people using maternity services is affected by racial stereotypes and a lack of cultural awareness among staff. One midwife said, “The NHS is amazing, but it was built by white people for white people. We need to adapt, because now we have a diverse population and workforce.”
Social care Adult social care providers are facing increased running costs, including food and electricity, with some struggling to pay their staff a wage in line with inflation, which affects recruitment and retention. This is likely to have an impact on people, both in the quality of care they receive and in providers’ ability to re-invest in care homes – data from CQC’s Market Oversight scheme shows that care home profitability remains at historically low levels. Local authority budgets have failed to keep pace with rising costs and the increase in the number of people needing care. As local authority funded adult social care places are often less profitable, there is the risk that people who live in more deprived areas, and are
more likely to receive local authority funded care, may not be able to get the care they need. Some people who pay for their own care at home have had to cut back on visits to support their basic needs, with one homecare provider telling CQC: “Due to the cost of living crisis and increased fuel prices, we have had to increase the rates for service users… the outcome was that some people have reduced their care visits to a minimum… this has impacted on their quality of life.”
Mental health Access to and quality of mental health care also remain a key area of concern. Gaps in community care continue to put pressure on mental health inpatient services, with many inpatient services struggling to provide a bed, which in turn leads to people being cared for in inappropriate environments – often in A&E. One acute Trust reported that there had been 42 mental health patients waiting for over 36 hours in their emergency department in one month alone. Ian Trenholm, CQC’s Chief Executive, said: “The combination of the cost-of-living crisis and workforce challenges risks leading to unfair care, with those who can afford to pay for treatment doing so, and those who can’t facing longer waits and reduced access. And the impact of unresolved industrial action on people can’t be ignored – it’s crucial that both parties work towards an agreement so strikes do not continue into the winter, when disruption will have to be managed alongside increased demand for urgent care and staff sickness. “Of course, workforce challenges for the
health and social care sector long pre-date the current industrial action. The publication of the NHS Long Term Workforce plan has been a positive step, but implementation will be challenging – particularly without a social care workforce strategy to sit alongside it. We continue to call for a national workforce strategy that raises the status of the adult social care workforce and ensures that career progression, pay and rewards attract and retain the right professional staff in the right numbers. It is encouraging that Skills for Care has made this an area of focus. “We remain concerned that some people
are more likely to have a poorer experience of care. To better understand barriers to equality, we’ve commissioned research with midwives from ethnic minority groups, and with people from ethnic minority groups with long-term conditions. We’ve also worked with our expert advisory group for autistic people and people with a learning disability to develop a clearer and stronger position on the use of restrictive practice – we expect all providers to recognise restrictive practice and to actively work to reduce its use. “Maternity services and mental health services have been a particular area of inspection focus for us this year, and while we have seen some good practice, we have seen too many examples of poor care, and have taken action to protect people when necessary. “However, it’s important to say that we have also seen staff and leaders across all sectors mitigating risks arising from staffing shortages and working hard to deliver good care in very challenging conditions.” Ian Dilks, Chair of CQC, also commented:
“The challenges described in this year’s State of Care are to some degree caused by a lack of joined-up planning, investment, and delivery of care. Integrated care systems present the opportunity of bringing together local health and care leaders with the populations they support to understand, plan, and deliver care at a local level. This would in time move some of the focus of care away from big institutions and towards local and self-care provision, with autonomy to act on local population needs and an increased focus on preventing poor health, not just treating it. “However, in our first look across local care
systems, we found that while all systems have some equality and health inequalities objectives, these plans do not all have timeframes and measures. All systems need clear and realistic goals – and support to achieve these – that reflect how they will address unwarranted variations in population health and disparities in access, outcomes, and experience of health and
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