HEALTHCAR E DE LIVE RY
COVID crisis turns ‘fault lines into chasms’
A new report by the CQC reveals the state of health and social care and warns that COVID-19 is turning ‘fault lines into chasms’ as health inequalities are magnified and problems exacerbated for services already deemed to be ‘fragile’.
The Care Quality Commission’s (CQC’s) annual assessment of the State of Health and Social Care In England reveals that COVID-19 is magnifying inequalities and “risks turning fault lines into chasms”. The Commission warns that the focus now must be on shaping a health and care system that “delivers for everyone”. The report found that pre-COVID-19, care was generally good, but with little overall improvement. In the NHS, improvement in some areas, including emergency care, maternity and mental health, was slower than others. More than half of urgent and emergency care services were rated as ‘requires improvement or inadequate’ as at 31 March 2020, while a quarter of maternity services were rated as ‘requires improvement’. In mental health services, inspectors continued to find poor care in inpatient wards for people with a learning disability and/or autistic people. The overall proportion of services rated as inadequate rose from 4% to 13% – almost entirely based on deterioration in independent services, rather than NHS services.
The social care sector was found to be “fragile” as a result of the lack of a long-term funding solution, and in need of investment and workforce planning. In March 2020, CQC’s Market Oversight report highlighted that, in the absence of mitigating action, any further shocks to the labour market would be expected to increase the existing level of market fragility, place more pressure on local authority finances and could increase unmet care needs. There have been short-term interventions since that point, but the need for a longer-term funding plan has still not been addressed. In primary medical services, the fact that the overall ratings picture remained almost unchanged, with 89% of GP practices rated good and 5% outstanding masked a more volatile picture, with some practices deteriorating and a similar number improving. However, the CQC pointed out that, following the arrival of COVID-19, the progress achieved in transforming the way care is delivered has been “extraordinary”. In a matter of days, services developed new procedures and ways of working, often
taking advantage of technology. Changes which were expected to take years – like the switch to more flexible GP consultations by phone and online – took place almost overnight. The report highlights many examples of collaboration among services which have made a real difference to people’s care. The challenge now will be to keep and develop the best aspects of these new ways of delivering services, while making sure that no one is disadvantaged in the process. At the start of the pandemic, the focus on acute COVID-19 care was driven by the urgent imperative that the NHS should not be overwhelmed. Decisions were made in order to ensure capacity as quickly as possible – but the CQC says that priorities now need to be reset in a more sophisticated way to ensure that the longer-term response includes everyone, regardless of what kind of care they need, or where they receive it. The report stated that the resetting of priorities should start with local leaders seizing the opportunity to collaborate and building capacity to respond together to the needs of their area. The fact that the impact of COVID has been felt more severely by those who were already more likely to have poorer health outcomes – including people from Black and minority ethnic backgrounds, people with disabilities and people living in more deprived areas – makes the need for health and care services to be designed around people’s needs all the more critical. Over the summer, CQC reviewed the way health, social care and other local services worked together in 11 parts of the country. There were differences in the way they responded to the pandemic but there was evidence that the places with established working relationships and an understanding of need in their local areas were better able to care for the local population in a time of crisis. The reviews have brought into focus the learning that needs to be used to help plan for a longer-term response to the virus. The CQC
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