State of Care 2018

Care Quality Commission logo

The Care Quality Commission (CQC) has published its annual State of Care Report today. This important insight into the health and care sector across England is, as ever, a mix of realism, optimism and pessimism.

Importantly, CQC recognises the extreme pressures on the sector (whilst acknowledging some pressures like workforce) are felt across the economy.

This year’s Report shows that most people are still receiving good care – when they can access it. Overall quality has been maintained since last year –and improved in some areas (Oxfordshire continues to perform better year on year with 90% of adult social care now rated as good or outstanding) – despite challenges around demand and funding, as well as the significant workforce pressures, as all sectors struggle to recruit and retain enough staff to deliver existing provision, let alone expand to meet demand..

The efforts of staff, leaders and carers to ensure that people continue to receive good, safe care despite these challenges must be recognised and applauded, says CQC.

The adult social care sector continues to be fragile, particularly in home care, with many providers handing contracts back to local authorities, or as happended recently to Cherwell Care Services Ltd, lose the fight to maintain an unsustainable business. Unmet needs continue to rise, says CQC, and the number of older people living with an unmet care need has risen by almost 20%. In October, an announcement was made by Government to provide short-term funding for adult social care, but no long-term solution has been agreed to date.

CQC states that it is clear that people’s experience of care varies depending on where they live; and that these experiences are often determined by how well different parts of local systems work together. Some people can easily access good care, while others cannot access the services they need, experience ‘disjointed’ care, or only have access to providers with poor services.

CQC’s reviews of local health and care systems found that ineffective collaboration between local health and care services can result in people not being able to access the care and support services in the community that would avoid unnecessary admissions to hospital, which in turn leads to increased demand for acute services.

The most visible impact of this is the pressure on emergency departments as demand continues to rise, with July 2018 seeing the highest number of attendances on record.  Emergency departments are the core hospital service most likely to be rated requires improvement (41%) or inadequate (7%). A struggling local hospital can be symptomatic of a struggling local health care system. This indicates that – although good and outstanding primary care is more evenly distributed – there are parts of the country where people are less likely to get good care.

CQC goes on to state that there is a less immediately visible impact when health and care services do not work well together – on people, like those who use mental health services, who may already have more difficulty accessing support or to have to travel unreasonable distances to get it. For example, inappropriate out of area mental health placements – with some people being placed hundreds of miles from their homes – vary considerably by region. And CQC’s review of children and young people’s mental health services found that some children and young people were ‘at crisis point’ before they got the specialist care and support they needed, with average waiting times varying significantly according to local processes, systems and targets. Coverage of this area of the sector was widespread yesterday on World Mental Health Day.


As at 31 July 2018:

  • 3% of all adult social care services were rated outstanding (2017 : 2%)
  • 79% of all adult social care services were rated good (2017 : 78%)
  • 17% of all adult social care services were rated requires improvement (2017 : 19%)
  • 1% of all adult social care services were rated inadequate (2017 : 1%)

As at 30 September 2018, for Oxfordshire adult social care services:

  • 6.3% were rated Outstanding
  • 84.2% were rated Good
  • 9% were rated Requires Improvement
  • 0.5% were rated Inadequate