The new inspection ratings systems introduced in 2013 (whereby services are rated as outstanding, good, requires improvement or inadequate, as well as inspections being more comprehensive) has now been used enough to build a picture of how care services are performing.
The headline statistic, picked up by much of the press, is that two-thirds of hospitals were deemed to be inadequate or requiring improvement. While the figure in the report is based on inspections to May 2015, the proportion is maintained when including more recent inspections.
One particularly interesting comment for providers is that, while there were fewer inspections as the new system bedded in, the proportion of inspections resulting in enforcement activity increased by 75% on the previous year (from 4% to 7%). Whether this can be seen as the new inspection system "working" is subjective, but it appears more likely that the new type of inspection is uncovering more problems, rather than services rapidly deteriorating to a level requiring enforcement action.
The report also comments on the impact of the latest regulatory changes, including the introduction of the duty of candour and fit and proper persons test. The report states that CQC has not yet identified a breach of the fit and proper persons test, despite previous media reports that the first referrals to CQC under the test were received in January. It is unclear whether these early referrals are still being investigated, although it seems more likely that the individuals were not found to be unfit. The report suggests the new test is having a deterrent effect as providers have become aware of it, rather than it being used retrospectively as part of enforcement action. Similarly, the report states that providers are aware of the duty of candour, particularly NHS Trusts for whom the duty was introduced first, and CQC has seen positive evidence of it being applied when care had gone wrong. It would appear that, as yet, no regulatory action has been taken to enforce the duty.
Some of the most concerning findings relate to adult social care services. The report emphasises the financial difficulties in this sector, particularly stating that statutory funding for social care has decreased by £4.6 billion (31%) over the last five years. As a result local authorities "have tightened their eligibility criteria, cut back on what is provided in care packages and reduced spending on preventative care", resulting in 400,000 fewer people receiving publicly funded care services than in 2009/10. At the same time, since April CQC has been responsible for market oversight of the largest adult social care providers, in addition to monitoring the care they provide, as a result of the failure of Southern Cross. To add pressure to the situation, since the Supreme Court ruling in 2014 clarifying when Deprivation of Liberty Safeguards (DoLS) should be in place, there has been a 10-fold increase in DoLS applications. There is also variation in how DoLS is applied between care homes, although this will hopefully even out as providers become more familiar with their duties.
Despite the many concerns listed in the report and the media about the care sector, the report also makes clear that there is a huge amount of good work being done. The report highlights that almost three quarters of providers find inspections had helped to improve the service being provided, and the majority of ratings had improved where a service had been re-inspected. The report also provides examples of some of the best care being provided across the country. While poor care will always be a cause for concern, it is clear that the hard work of those in the sector is vital, and the vast majority of people are working to improve it.