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Jeremy Cooper

CQC’s State of Care report – brilliant, but flawed

The annual CQC State of Care Report was published today, giving a once-a-year chance to reflect on the overall condition of health and care. The strongest distinction the report draws is between quality of care, and access to care. In his foreword, Chief Executive Ian Trenholm compares the (generally) positive quality of care that people receive with the problems and differences they experience accessing care, and calls this difference the ‘integration gap’.

I think this is a really helpful distinction. The report gives good examples of what well-managed interfaces look like, drawing on evidence CQC has collected from 31,184 different providers of care. Just reflecting on that number alone helps make the point that the interfaces and boundaries between all these organisations are of critical importance.

(As a quick aside, breaking the number of providers down further shows the imbalance in the system. 93% of the providers are social care providers and GPs, who between them account for around 15% of health and care spend. Compare that with the 70% of spend attributable to a group who make up less than 0.5% of all providers – NHS acute hospitals. Joining up system actors is essential, but let’s be clear – this is not about joining up 31,184 equals.)

However, where I strongly disagree with the report is the leap from pointing out access differences to quantifying unmet need. Discussing the report with my colleagues, we all jumped on one statistic – the ‘1.4 million people with unmet needs’. This statistic doesn’t come from analysis of the mountain of CQC insight. It comes from analysis completed by Age UK and is based on the number of older people who received care a few years ago compared with those who are now receiving care.

This was valid research, but it does not prove the point CQC are claiming. The figure of 1.4 million people has been widely used, including in the LGA’s Adult Social Care Green paper, which takes it further by laying calculations on top of the assumptions involved. iMPOWER has demonstrable evidence (from case reviews undertaken with local authority clients) that some of those who were counted as previously receiving care but no longer receiving it, are actually living better lives with less, different or no statutory support.

As my colleague Sam Griffin pointed out, the report states that the number of older people living with unmet care needs continues to rise, with friends and family carers often filling the gap. This is the wrong way round to look at it, even according to the Care Act. Statutory services are there to fill the gap where people’s own strengths, assets and social networks aren’t enough – not the other way around.

CQC should be congratulated for moving the debate forward, from quality to access. And they are right to point out that unmet need is a worry. But we simply have to move away from assuming that reductions in service necessarily equate to unmet need. Until we do, we have no hope of changing social care.

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