The CQC has published its 2023 State of Care Report, providing a nuanced and holistic view of challenges faced by the health and social care system in England

29 November 2023

The CQC has published its 2023 State of Care Report (the "Report"), providing a nuanced and holistic view of challenges faced by the health and social care system in England. Data from this year's Report highlights the growing inequalities and access problems across the health and social care system, amplified by staffing pressures and increased running costs. The CQC warns that it is increasingly the case that patients receive the care that they can afford, rather than the care that they need.

Staffing pressures across the health and social care workforce

Statistics relating to job satisfaction, pay and staff retention across the health and social care workforce continue themes from previous reports:

  • Only 26% of NHS staff believe that the NHS is adequately staffed- a five year low. On a related note, 32% of NHS staff said "they often think of leaving their organisation", up from 27% in 2020. The Report emphasises the impact that pay dissatisfaction and stressful working conditions (exacerbated by staffing shortages) are having on NHS staff.
  • Satisfaction with pay within the NHS has reduced considerably (by 12 percentage points since 2019) and only 26% of NHS staff are satisfied with their level of pay.
  • In the adult social care sector, 54% of providers in England were struggling to recruit new staff, and 31% said they struggled to retain staff, with knock-on effects for service capacity. Many adult social care providers are unable to raise wages in line with inflation. The median hourly pay for social care workers is 9p lower than the median hourly pay for retail workers.

Staffing pressures, including skills gaps and understaffing, is resulting in those remaining within the sector feeling "under-staffed and overworked", with negative impacts on staff wellbeing. This is affecting the quality of care provided, particularly within urgent and emergency services, end of life care and adult social care.

Access to care

People getting access to the care they need, when they need it, is a challenge across a broad spectrum of NHS and social care services. The Report highlights the following issues:

  • Long waits for hospital care. A record 7.6 million people currently await planned hospital treatment, a 12% increase on the previous 12 months.
  • Patients experiencing difficulties accessing their GPs. Satisfaction with GP appointment times is at its lowest in 6 years. Of a survey of 750,000 people, 16% said they were unable to get an appointment when they last tried to make one. The Report also highlights the 'hidden waiting list': the time it takes between a patient's first GP contact and their referral to hospital. 18% of patients who are ultimately referred to hospital, have to visit the GP at least four times before receiving their referral.

  • Long GP wait times are impactingurgent and emergency care. The number of people attending A&E as the first point of contact has increased on previous years as people were unable to access the GP or their condition had deteriorated while awaiting a GP appointment.
  • CQC providers of health and social care receive more referrals than previous years, but were unable to accept new clients as there was insufficient care staff to meet demand. Adult social care providers cited lack of staff as "their biggest barrier to providing good care".

Inequalities

Ethnic Inequalities: The CQC Report highlighted ongoing ethnic inequalities, particularly within neonatal and mental health care. The CQC consulted midwives from ethnic minority groups on their own experiences and how they have seen ethnic minority patients treated. Midwives cited systemic issues within the NHS relating to communication with patients in languages other than English, a culture of racially stereotyping patients and midwives, and a lack of education surrounding health problems which disproportionately affect the ethnic minority population.

The cost of living: The cost of living crisis is regarded as the primary societal factor in worsening health. Over half (58%) of respondents on lower incomes felt there was a discrepancy between how well they took care of their health and how well they ought to, compared with 39% of high income earners.

The number of people using private healthcare is on the rise: Around 8 in 10 of people who had used private healthcare in the last year said they had always or typically used the NHS previously. More than half of people who used private healthcare cited NHS wait times as the reason for their transition to the private sector. The CQC acknowledges the risk of a "two-tier system of healthcare, with those who can't afford to pay having to wait longer for care and risking deteriorating health".

Looking forward

Integrated Services: Following the introduction of integrated care systems (ICS) and integrated care boards under the Health and Care Act 2022, there will be increased focus on how ICS can improve outcomes, tackle inequality, and better serve patients and staff in what is a turbulent time for the sector.

National Workforce Strategies: The Report emphasises the need to effectively implement the NHS Long Term Workforce plan to address workforce pressures within the NHS, accompanying this with a strategy to raise the status of health and social care professionals. These measures aim to ensure that sufficient progression and pay incentives are offered to attract and retain staff in the numbers required to provide the standard of care necessary to ensure patient satisfaction and wellbeing.

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