Workforce holds key to care gridlock

The regulator’s annual assessment of the health and care sector -- The state of health care and adult social care in England 2021/22 -- reported that most people are still receiving good care when they can access it. But too often, there were problems with access. Capacity in adult social care has reduced and unmet need has increased. And only two in five people are able to leave hospital when they are ready to do so, contributing to record-breaking waits in emergency department following a decision to admit and dangerous ambulance handover delays.

Ian Trenholm (pictured), CQC chief executive said the gridlock meant people were stuck. ‘Stuck in hospital because there isn’t the social care support in place for them to leave, stuck in emergency departments waiting for a hospital bed to get the treatment they need, and stuck waiting for ambulances that don’t arrive because those same ambulances are stuck outside hospitals waiting to transfer patients,’ he said.

He added that there were no quick fixes, but there were steps to be taken on planning, investment and workforce that will counter further deterioration in access.

The report highlighted growing workforce problems, with increasing numbers of staff leaving health and social care and providers finding it difficult to recruit. ‘In many cases, providers are losing the battle to attract and retain enough staff,’ the report said, with more than nine in 10 NHS leaders warning of a social care crisis in their area.

Kate Terroni, chief inspector of adult social care, integrated care and CQC interim chief operating officer, welcomed the money announced by government to help speed up discharge from hospital, and to retain and recruit more care workers. ‘But there needs to be more focus on long-term planning and investment rather than short-term sticking plasters,’ she said. ‘With 165,000 vacancies in adult social care, there needs to be a real step change in thinking about how to attract and retain staff, with better pay, rewards and training linked to career progression. If this doesn’t happen, people will be at increased risk of harm.’

The is a need to champion the adult social care workforce and dispel the notion that it is low skilled work. The CQC called for funding and support for integrated care systems so ‘they can own and deliver a properly funded workforce plan that recognises the adult social care workforce crisis as a national issue and offers staff better pay, rewards and training linked to career progression’.

Matthew Taylor, chief executive of the NHS Confederation, said the concerns highlighted by the CQC were the consequence of insufficient long-term funding and support.

‘In particular, health leaders remain very worried about the situation across social care. Only two fifths of patients in hospital are able to leave when they are ready to do so, including due to problems accessing social care, yet the government still has not set out how and when its £500m winter investment will be released to the system,’ he said. ‘The 42 integrated care systems have the potential to drive forward improvements alongside providers, but they are being collectively held back by the government’s refusal to acknowledge the scale of the workforce and funding challenges and to provide adequate support.’

Nuffield Trust deputy director of research Sarah Scobie said the report painted a familiar picture. ‘Insufficient progress to plug severe staffing gaps across health and care and the effects of years of underinvestment have left the service ill-equipped to work through the backlog it already had, let alone the sharp increases in waits we have seen since the pandemic,’ she said.