Last year East Anglia Bylines undertook a detailed analysis of the Care Quality Commission (CQC) inspection reports for every residential care home and home care provider in the East of England. Now, one year on, a further analysis of the region’s adult social care reveals that not only have things not improved but, in some cases, they are worse. Our politicians and government are seriously failing those in need of social care.
The danger is in the detail
The inspection reports of over 1700 home care providers and 1600 care homes operating in East Anglia were analysed. The conclusions provided sober reading across the region but especially in Norfolk and Essex.
A residential care home or home care provider is rated by the CQC on a four-point scale. Outstanding, Good, Requires Improvement, and Inadequate. It applies that scale to five criteria – Safe, Effective, Caring, Responsible, and Well Led.
In 2022, 32 care homes received the lowest rating of Inadequate, meaning hundreds of vulnerable people are receiving a poor standard of care. Taken together this figure means that one in five care homes in the region is delivering a poor standard of care. In 2023 the number of Inadequate care homes increased to 33. Norfolk remains the worst performer, having over a third of the region’s care homes rated Inadequate.
A similar story is also true of home care and the care agencies that provide care and support for people in their own homes. In 2022, over 400 care agencies (nearly 1 in 3) were assessed as either Requires Improvement or Inadequate, or have yet to receive an inspection. In 2023, the number rose to over 600. That is over one in three of all home care providers. Essex has the highest number, with over 133, or one in five, of all the county’s providers falling into one of the above three categories.
What does ‘Inadequate’ actually mean?
The CQC defines Inadequate as being where “the service is performing badly and we’ve taken enforcement action against the provider of the service.” But what does this mean in reality for those receiving care?
In the case of Precious Homes, Hertfordshire, which was rated as Inadequate in 2022 and has since closed, the inspection report cited concerns over incomplete records, incomplete safety checks and a lack of care for some residents. The care home cited lack of staff as the cause, a situation that is hardly likely to improve if the recent government proposals on limiting the immigration of care worker dependents become reality.
In Norwich, Heath House, home to residents with dementia and metal health issues, was found to be Inadequate in all five criteria. The CQC report noted lack of cleaning resulting in soiled items not being dealt with, as well as concerns over safeguarding (i.e. providing a safe environment free from abuse and maltreatment), PPE and staff retention.
What is the Government’s response?
When the East Anglia Bylines investigation began in the summer of 2022, Boris Johnson was the prime minister, the health secretary was Sajid Javid and the head of state was Queen Elizabeth II. By the time the 2022 articles revealing the findings were published, the country had endured Liz Truss, and welcomed Rishi Sunak into Number 10 Downing Street and King Charles onto the throne. Since then there has been, in comparison to recent years, a degree of stability in government. This, in turn, has given the government a year to begin to repair the damage caused to social care and to prepare for the arrival of inevitable winter demands on the NHS.
In July the government reallocated £600 million away from social care reforms to give it to councils as part of a two-year deal to improve adult support services and ease immediate pressures. Much of the money is to increase the capacity of the workforce. Vacancy rates hit 9.9% in March 2023 and care workers are on the Shortage Occupation List. In September a further £10 million was made available for local authorities across the country to help reduce hospital admissions from care homes this winter and speed up hospital discharges. But despite the pledges, and statements, little has actually changed to address the underlying issues – a situation care providers describe as insufficient.
The social care crisis was widely covered, both in national media and in Committee meetings within Parliament itself, so the government is clearly aware of the situation. Yet the lack of action, while infuriating, is perhaps not surprising.
There is one recurring word in relation to adult social care that could be applied to the first year of the Sunak premiership.