On the 25^th October, the embattled Care Quality Commission released their annual State of Care report for 2023/24. It drew some interesting conclusions, and some worrying observations, though nothing that will surprise those familiar with the issues that beset the health and care sectors.

The CQC is the body that monitors the standard of health and social care services are in places like hospitals, GP surgeries, care homes and homecare services in England. (Other bodies do this job in the devolved nations). You can find out here who the CQC asked for this latest report, and where they got their data from.

Primary Care and Dentistry

The headline finding from the report is that (in a survey of 1,600), people are struggling most with getting an appointment to see a GP (59%) and a dentist (23%). In the last 4 years, the number of people waiting more than 14 days for a GP appointment increased by 18%. There are 400,000 more people waiting over 4 weeks, in the same period.

There’s a big regional variation in the proportion of NHS dental work being done – from 48% to 97%, with rural areas seeing much more private treatment. Astonishingly, 9.4 million people say they have performed DIY dentistry on themselves.

There was a worrying statistic that only 1 in 4 people with a learning disability are actually on the learning disability register. As GPs use that list to make sure these patients get the right care, this is a significant concern. It’s compounded by the fact that the checks for whether someone has autism are taking a year to happen in some cases, rather than the recommended 3 months maximum.

General Practice

Much of the data in this section of the report is from other organisations and was published in recent months or years:

• the latest RCGP poll showing 76% of members say patient safety is being comprised by excessive workload;
• the BMA survey recently showing 33% of locum GPs plan to change career, with 71% blaming ARRS;
• NHSE’s own data showing that monthly GP appointment numbers rose 24% between Feb 2020 and March 2024, but that 17% of appointments in March 2024 happened more than 2 weeks after booking;
• The 2024 GP survey that showed 74% of people said their overall GP experience was good, but that 13% said it was poor. But when answering about contact and access, 19% said it was poor, and 34% said it took too long to get the appointment.

·       However, the CQC also did 250 targeted assessments of practices from October 2023 to March 2024 and found that they were improving availability of appointments, and being proactive in patient outreach. There were outstanding examples of this, including one practice that set up an online system which could deal with all appointment booking, prescriptions, and general queries – with 70% of its patients signing up to it. They also put on more lunchtime and early morning appointment for working patients. The practice also had a register of patients who were vulnerable including Travellers and the homeless. A practice nurse followed up with them if they failed to attend. Good news stories such as this do exist throughout the report and are testament to the hard work and determination of staff to make the best of a difficult situation. Technology and data will continue to play a huge role for health and social care going forward.

Integrated Care Systems

The relatively new bodies called Integrated Care Systems (ICSs) continue to struggle in many places. The most challenged ones are in the South West, particularly more rural ones.

There are mixed views amongst ICS’s about how well they can help solve health inequalities – challenges include skills, governance, data and capacity. The CQC see three main issues with ICS’s:

• finance 
• joint forward planning
• workforce

However, the CQC’s formal work on ICS assessments in currently paused, and the CQC is itself going through a period of turmoil (read why here).

Adult Social Care

Here, demand is far outstripping supply. There was a 27% increase in new requests for social care support that weren’t provided, since 2017.

Bed-blocking in hospitals continues to be a major issue; waits for care home beds made up 45% of the delays when someone can’t be discharged from hospital. That’s 4,000 on an average day.

Staffing

The good news is that staff vacancies in care homes were at their lowest in 3 years. But there are problems on the horizon when it comes to overseas workers who have traditionally provided a huge amount of help in the care sector – international recruitment levelled off last year and has started falling steeply – a shocking 81% fall in the period April to July 2024 compared with the same period in 2023.

Mental Health

The picture here continues to be very serious indeed. Demand is growing steeply, especially from children, women and ethnic minorities, but many cannot access help. The CQC did a special review of Nottingham NHSFT and found people waiting months and even several years for treatment.

What’s Working Well

The voluntary sector and community groups have had success in identifying groups of people that are often unheard and are at risk of suffering the most inequalities. What needs to happen now though is for Local Authorities to engage better with these groups to understand them and their needs.

Data sharing is getting better slowly, and is beginning to make moving between hospitals and the community safer.

How Thornfields Can Help

Thornfields has a number of courses which you and your organisation may find helpful in a number of the areas that the CQC covers in their report:

•    Improving the Patient Experience
•    Introduction to PCN Finances
•    Managing Change in Healthcare
•    Recruiting the Right Person

Workshops to help you get the most from your existing resources

•    Active Signposting
•    Care Navigation
•    Correspondence Management
•    Health and Safety for Care Managers

CQC-specific Workshops:

•    Meeting the CQC Standards
•    Preparing for CQC Inspection

Read FPM’s article on what the recent Dash report means for the CQC and download our exclusive guide by clicking here.