Sue Robb of 4Children talks to Julie Laughton and Alison Britton from the Department for Education about the role of childminders in delivering the 30 hours free entitlement.
Public facing a growing ‘care injustice’
A new report from the Care Quality Commission has warned that the public is facing a growing ‘care injustice’ as people are finding it more difficult to get help in England.
The State of Care paper highlights growing hospital waiting lists, delays at A&E and record dissatisfaction levels with GPs, while also detailing how mental health and old-age care were also becoming harder to access.
While the CQC states that the majority of services were rated as good or outstanding and the quality of care was being maintained, the annual review pinpoints examples of a lack of out-of-hours GP care, rising rates of preventable admissions to hospitals, overcrowding on wards and worsening A&E waiting times, a growing waiting list for routine operations and mental health patients being made to travel long distances for treatment.
Specifically, the Isle of Wight, Kent, Wirral and Portsmouth have been singled out as the four areas where access to good hospital and social care is problematic, with poorer-than-average care services and struggling hospitals leaving inspectors unsure about the likelihood of future improvements. This is because the Isle of Wight's only hospital has an inadequate rating, there are seven local hospitals in Kent that are all judged to be not good enough, while nearly half of home care services in Portsmouth and its main hospital are not up to scratch.
Ian Trenholm, chief executive of the CQC, said: “This year’s State of Care highlights both the resilience and the potential vulnerability of a health and care system where most people receive good care, but where access to this care increasingly depends on where in the country you live and how well your local health system works together. This is not so much a ‘postcode lottery’ as an ‘integration lottery’.
“We’ve seen some examples of providers working together to give people joined-up care based on their individual needs. But until this happens everywhere, individual providers will increasingly struggle to cope with demand – with quality suffering as a result. There need to be incentives that bring local health and care leaders together, rather than drive them apart. That might mean changes to funding that allow health and social care services to pool resources. Like the digital monitoring devices for patients’ clinical observations that have saved thousands of nursing hours, the e-prescribing in oncology that’s helping people directly, and the electronic immediate discharge summaries that have improved patient safety.
“The challenge for Parliament, national and local leaders and providers is to change the way services are funded, the way they work together and how and where people are cared for and supported. The alternative is a future in which care injustice will increase and where some people will be failed by the services that are meant to support them, with their health and quality of life suffering as result.”
The Local Government Association’s Ian Hudspeth said: “This report raises important concerns and highlights the brilliant work across the system to maintain quality of care, something that becomes harder each year as the consequences of pressures build further. It also provides yet more evidence of a system under significant pressure and in desperate need of securing a more long-term and sustainable solution for how, as a country, we pay for social care.
“Over recent years, councils have protected adult social care relative to other services. But the scale of the overall funding picture for local government as a whole means adult social care services still face a £3.5 billion funding gap by 2025, just to maintain existing standards of care. The likely consequences of this are more and more people being unable to get quality and reliable care and support, which enables them to live more fulfilling lives. Action is needed, which is why, following government’s decision to delay its green paper on adult social care, the LGA published its own green paper consultation to drive forward the public debate on what sort of care and support we need to improve people’s wellbeing and independence, the need to focus on prevention work, and, crucially, how we fund these vital services. The government must use the Budget and Spending Review to inject desperately needed funding into adult social care and use the green paper to secure the long-term sustainability of the system."
David Williams, County Councils Network spokesman for health and social care, and leader of Hertfordshire County Council, said: “Today’s report from the Care Quality Commission is another powerful example of the need for a holistic, long-term solution to adult social care and that investing in the NHS but not social care is a false economy. The report found that people are still receiving good local social care, which is testament to the hard work local leaders’ and health professionals have put in, but found that in some places the integration agenda is behind schedule, despite the best efforts locally.
“Without policy and resource directed towards care in the community, with councils at the heart of integration, there is a risk we store up problems for the future. If all of the NHS’ windfall in spent within the national service, then this funding will be spent treating people in crisis, rather than in preventative care that keeps them out of hospital and allows them to live independent and healthier lives for longer. This should give ministers food for thought when deciding how and where to distribute this money.”