What did the State of Care Report 2023 have to say about the adult social care sector and care homes in particular?
The short summary is that not much of significance has changed. The sector still faces systemic and interconnected issues related to local authority funding, provider financial viability, staff shortages, lack of capacity and staff wellbeing.
Inflation and increased minimum and living wage rates only exacerbate the issues and drive greater inequality when it comes to access to care services. Meanwhile, care home profitability remains at a historically low level.
In the face of such deep-seated nationwide issues, care home groups will inevitably need to explore ways to improve operating efficiency, foster better collaboration with healthcare professionals and support care teams to work more effectively.
Funding and Staffing
From the report:
‘Some providers are struggling to pay their staff a wage in line with inflation.
Over half of the respondents to our survey of adult social care providers in England said they were having challenges recruiting new staff, and 31% said they were having challenges in retaining them.
Despite this, there has been a steady decrease in staff vacancy rates for care homes, from 11% in January to March 2022 to 7% in April to June 2023.’
To pick out a couple of issues: why would a care worker leave their job? It’s unlikely that many would achieve a substantial pay increase by moving to another provider (unless it came with a promotion). Some leave the sector altogether, perhaps for more pay and less stress, and some might simply move to a provider where they feel they’ll be better supported.
Staff support appears to be a significant factor:
‘Increasing demand and pressures on staff are taking a toll on their mental health and wellbeing. Staff have told us how, without the appropriate support, this is affecting the quality of care they deliver.’
‘Staff in both residential homes and care homes with nursing have also described feeling they are unable to provide adequate care and support due to a shortage of staff, lack of funds and absent or poor management.’
So one question for care home groups is whether their management systems support staff to do the best job possible. This has many facets – from the way that staff rosters are organised through to care planning and documentation.
Burdensome paperwork that gets in the way of care delivery is demotivating and may affect staff retention.
Overseas Recruitment
Reduced staff vacancy rates are largely due to greater recruitment from overseas. Each care home group has its own experience but, across the board, 70,000 people from overseas took up direct care roles in the independent care sector.
This implies there are many thousands of care workers who are new to the UK care system and may not have English as their first language.
Standardising and enforcing processes through efficient management systems becomes more important from the perspective of productivity and risk management.
State and Self-Funded Care
Care homes providing care for older people remained those with the highest proportion of self-funded care (49%). Smaller care homes, with 1 to 19 beds, remained those with the lowest proportion of self-funded care (12%).
From 1 March 2022 to 28 February 2023, there was a significant 3% increase in the number of people living in a care home. Of these, 37% funded their own care, which is an increase from the previous year.
60% of care homes had a mix of self-funded and state-funded residents. Care homes rated as outstanding tended to have a higher percentage of self-funded residents. In other words, money does have an impact on standards of care.
The Autumn 2022 survey from ADASS found more than 9 in 10 adult social services directors in England did not believe there was the ‘funding’ or ‘workforce’ to meet care needs of older and disabled people in their area ahead of winter 2022/23. This is having a significant knock-on effect on unpaid carers.
Maximising existing use of capacity is essential. This can be improved through more efficient clinical assessments, streamlined admissions and better resource planning within providers.
Integrated Health and Care
Better integration of health and care services is a long-standing ambition. Integrated Care Boards (ICBs) are responsible for developing plans for meeting the health and care needs of their local populations, which includes enabling sufficient access to care homes and community-based services.
It’s early days for Integrated Care Systems but it’s our view that efficient data sharing remains a key challenge. Adopting common data standards will allow care homes using digital care planning systems to share data securely with other health and care professionals.
‘Insufficient capacity in adult social care is continuing to contribute to delays in discharging people from hospital. Ongoing staffing and financial pressures in residential and community services are having an impact on the quality of people’s care, with some at greater risk of not receiving the care they need.’
As of January 2023 there were still 12,000 people occupying hospital beds who could have been discharged into the social care system. Occupancy rates in registered care homes were at 84% in July 2023.
There may be several factors behind delayed discharge issues including matching availability of specialist nursing care and facilities with demand and the fact that homes are running below capacity because of staffing shortages.
A recent survey by the Association of Directors of Adult Social Services (ADASS) found that 99% of respondents expected increased pressures on the NHS to result in additional pressures for adult social care in the next year.
‘…over the last year we have seen increasing pressure to discharge people from hospital. In the face of this pressure, we have heard examples of people being discharged too early without appropriate risk assessment or having a care package or intermediate care in place. Unsafe discharges are putting people at risk, potentially leading to poorer outcomes in their health and care, and being readmitted to hospital. During the 12 months to June 2023, on average around 9% of people had to go back to the emergency department within 7 days of their previous attendance.’
In its Autumn 2022 statement, the government announced up to £2.8 billion in 2023/24 and £4.7 billion in 2024/25 to help support adult social care and discharge from hospital.
Meanwhile, 434,243 people were waiting for an assessment, care and support to begin in August 2022 while 82,000 were waiting more than 6 months for an assessment of their care needs.
Improved clinical assessment and admission processes within care homes would also help accelerate transfers and ease pressure on NHS beds.
Technology
The report doesn’t have much new to say about technology other than some aspirational points about Artificial Intelligence (AI).
‘Innovation and improvement varies, but the use of artificial intelligence (AI) in health care has the potential to bring huge improvements for people. Given the speed of growth of AI, it is important to ensure that new innovations do not entrench existing inequalities.’
AI will deliver benefits in the future. In the meantime – in our view at least – the priority should be to use existing, proven technology to its full potential to improve operating efficiency and care standards within care homes, along with closer collaboration with healthcare professionals to support efficient transfers of care.
Deprivation of Liberty Standards (DoLS)
There’s a lengthy section dedicated to DoLS – specifically delays in assessments and also the application of DoLS safeguards within providers.
‘People subject to DoLS authorisations are not always clear about the detail of their situation. This lack of communication also affects families and carers. Families often do not understand the DoLS system and are not given information about their roles and rights.’
Some of the issues are inevitably resource-driven. But some are also driven by training, process and record keeping. While there’s no magic wand available all of these issues are more manageable within a modern digital care management system.
Summary
Significant challenges remain. Given that 2024 is an election year it seems unlikely that these structural and funding issues will be resolved in the short-term. For care homes and care home groups this makes it essential to look at how better technology and management systems can help improve efficiency and communication while also reducing the risks that inevitably come with overstretched resources.
You can access the full CQC report by visiting the following link: https://www.cqc.org.uk/publications/major-report/state-care/2022-2023
