The government’s desire to move to community care is threatened by a lack of investment in capacity for a system under strain.
The health and social care system remains fragmented and under severe strain as it prepares for a shift from hospital to community care.
The annual state-of-care report from the Care Quality Commission (CQC) has warned that while there is some evidence of innovation, community services need significant investment in both capacity and capability to deliver the transformation in people’s care called for in the government’s 10 Year Health Plan.
Without more support to help community services deliver the vision of the plan, there is real risk of erosion in care quality, with people struggling to get the care they need and the most vulnerable groups likely to be hit hardest through longer waits, reduced access and poorer outcomes.
The report also highlights longstanding inequalities with some groups of people – including older people, people with dementia, people with a learning disability, and those with complex mental health needs – more likely to struggle to navigate services, often meaning their families and unpaid carers carry increasing burdens.
As Healthcare Today recently reported, district nursing services, which are intended to provide care for patients and support for their families at home, in clinical settings and in care homes, are struggling.
More support needed
“The government’s 10 Year Health Plan is a real chance to improve care by putting people’s needs first,” said the CQC’s interim chief executive Arun Chopra. “But for the plan to succeed, community health and care services need more support. Without this, there’s a risk that fewer people will be able to access good care, with vulnerable groups hit hardest”.
Demand for local authority-funded social care support continued to rise in 2023/24. While vacancies in the workforce have fallen to pre-pandemic levels, the vacancy rate in adult social care is still three times higher than in the wider job market. Homecare services are particularly affected, with vacancy rates more than twice as high as those in care homes.
The end of new care worker visas is likely to put further pressure on recruitment, making it more important than ever that a sector-wide workforce strategy is agreed and the recently announced fair pay agreement has an impact.
More community services are urgently needed to help people stay in their own homes longer. However, CQC has identified factors that could limit the growth of the home care sector. Providers are handing back contracts to deliver care back to commissioners due to rising costs, and an increasing proportion of the market is made up of very small providers that may be less financially resilient than larger providers.
CQC’s local authority assurance work has found delays for people in getting access to home care due to shortages of both home care staff and in the workforce delivering short-term care to people recovering at home after a hospital stay. Capacity in rehabilitation, reablement and recovery services is consistently the biggest cause of delayed discharges nationally.
