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The State of Care


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The Care Quality Commission has just published its annual state of care report looking at the quality of health and social care and the issues facing these vital sectors.

It’s widely acknowledged that both health and care are facing a fairly acute funding crisis, the CQC highlighted the good – that quality of care is still going up (however more slowly) where need for improvement has been pointed out.

But there is also a story, that will surprise no one who works in the sector, that there is a problem with access to service and even more access between services.

“It cannot be right that people’s care depends on where they live or the type of support they need. But this is not so much a ‘postcode lottery’ as an ‘integration lottery’. In our review of local health and care systems, we found that in too many cases,  ineffective coordination of services was leading to fragmented care. Funding, commissioning, regulation and performance management all conspired to encourage a focus on individual organisational performance, rather than ensuring people got joined-up care based on their individual needs,” writes CQC Chief Executive Ian Trenholm.

One of the key issues in across all areas of care is that adult social care is under funded. There was a clear link between adequate and sustainable funding for adult social care and the rest of the system. People are spending time in hospital that they don’t need to – it’s not good for them and it’s not good for the bottom line in health. Delayed transfers of care and avoidable admissions are resulting from a lack of access to good social care.

Beyond that, Professor Steve Field, the departing Chief Inspector of General Practice who has also been leading the review of integrated services pointed to problems in commissioning.  But the CQC is only able to inspect the services of providers and conduct reviews into areas which are funded – and scoped – by the Department of Health. A widespread review of adult social care commissioning practices is outside their purview.

Of course the problems of integration aren’t just related to problems in commissioning and funding in adult social care. Generally, there will always be difficulty where different objectives, performance frameworks and budgetary pressures make aligning organisations to achieve shared outcomes difficult. The CQC has found that where there is these alignments and genuine willingness to focus on the individual and their needed outcomes that integration can lead to better care and better access to care.


The LGiU will shortly be publishing a paper on commissioning for outcomes in adult social care and developing monitoring that aligns all providers. We will also be covering the State of Care report in a forthcoming briefing available only to LGiU members.