HEALTHCAR E DE LIVE RY
says that it is essential that the right support is available for all parts of a local health and social care system to drive improvements where they are needed, and to involve voluntary and community organisations in promoting health and wellbeing. The regulator concluded that COVID-19 has not only exposed but exacerbated existing problems in social care. The sector, already fragile, faced significant challenges around access to PPE, testing and staffing – and coordinated support was less readily available than for the NHS. The long-standing need for reform, investment and workforce planning in adult social care has been thrown into stark relief by the pandemic. The report makes clear that these issues need to be urgently addressed – underpinned by a new deal for the care workforce, which develops clear career progression, secures the right skills for the sector, better recognises and values staff, invests in their training and supports appropriate professionalisation.
In the NHS, emergency departments now face the prospect of a winter which combines pre-existing pressures with the urgent demands of the pandemic. As other services restart, physical distancing will provide significant challenges, both logistically and in terms of managing capacity, alongside a backlog of people who were unable to access care during lockdown. The impact of COVID-19 on the NHS in terms of elective, diagnostic and screening work has been enormous. Some life- changing operations have still not been rescheduled and there are people whose cancer has not been diagnosed or treated. The CQC said there must be learning to ensure that non-COVID-19 patients are not left behind, as we enter a second wave, adding that the NHS is already working hard to develop innovative solutions. The regulator believes that collaborative partnerships between providers could help to protect services, so people get the care they need. With the recognition that COVID-19 has fundamentally changed so much, it is important to recognise what has not changed. Problems that existed before the pandemic have not gone away – and people are still more likely to receive poorer care from some types of services for reasons that pre-date COVID-19. CQC said that it will maintain scrutiny on these services, supporting improvement and taking action to protect people where necessary – and will continue to highlight factors, including commissioning and staffing, which impact on care but cannot be resolved at provider level alone and demand a national response. Ian Trenholm, chief executive of the CQC, said: “Pre-COVID, the health and care system was often characterised as resistant to change. COVID has demonstrated that
NOVEMBER 2020
this is not the case. The challenge now is to maintain the momentum of transformation, but to do so in a sustainable way that delivers for everyone – driven by local leadership with a shared vision and supported by integrated funding for health and care. “There is an opportunity now for Government, Parliament and health and care leaders to agree and lay out a vision for the future at both a national and local level. Key to this will be tackling longstanding issues in adult social care around funding and operational support, underpinned by a new deal for the care workforce. This needs to happen now – not at some point in the future. “COVID is magnifying inequalities across the health and care system – a seismic upheaval which has disproportionately affected some more than others and risks turning fault lines into chasms. As we adjust to a COVID age, the focus must be on shaping a fairer health and care system – both for people who use services, and for those who work in them.” Responding to the publication, Dr. Jennifer Dixon, chief executive of the Health Foundation, said: “The CQC’s report illustrates the heavy toll the pandemic has taken on NHS and social care services despite heroic efforts from health and care workers. Even before COVID-19 a decade of underfunding and understaffing had undermined the resilience of the NHS and led social care to the brink. “The casualties are people. There is now a huge and growing backlog of people who need NHS care, which has built up because of the pandemic. The Government must not underestimate the time and investment that will be needed to tackle this very visible waiting list, with the avoidable suffering it represents.” Danny Mortimer, chief executive of
the NHS Confederation, commented: “The coronavirus pandemic continues to present the greatest challenge that we have experienced in a generation and the NHS entered it in a far from perfect state with significant workforce vacancies, increased demand, a poorly resourced social care sector, and a lack of sustained capital investment. “The fact that, yet again, the majority
of services have been rated as good and outstanding is down to the hard work of frontline staff right across the country, but the long-lasting impact of coronavirus could significantly derail this. We have seen how the NHS has innovated, collaborated and delivered for patients at a scale and pace never seen before and CQC has a vital role to play in supporting this to continue with a proportionate approach to regulation, which works with providers and their systems and does not add to their burdens. “The evidence about the disproportionate impact that the first wave of coronavirus had on exacerbating inequalities is overwhelming, yet we are hurtling towards the second surge with the Government seeming to have learnt very little about it judging by its limited and slow action particularly in relation to test and trace. This could now have a devastating impact on communities and on the NHS’s ability to cope.
“In our recent survey, fewer than one in ten NHS leaders told us that their current funding allows them to deliver safe and effective services. CQC’s assessment must serve as a wake-up call to the Government to appropriately fund and resource the NHS and social care so that they can be equipped to deal with the aftermath from this pandemic, which will be felt for many years to come.”
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