Strained Realities: The Care Quality Commission versus Adult Social Care Pressures

The provision of quality care within adult social services stands at a critical juncture, facing an unprecedented challenge due to a myriad of factors. The primary issue being the sheer demand for care services, driven by an aging population and an increase in complex care needs. Added to this challenge is the weight of expectation placed upon care providers by the Care Quality Commission (CQC).

The CQC stands as a cornerstone in the realm of healthcare and social services regulation within the United Kingdom, assigned by legislation to protect and promote the well-being of those who receive care. 

However, whilst the CQC aims to uphold high standards of care, care providers will often say that its expectations often do not align with the stark reality of an ongoing adult social care crisis compounded by chronic underfunding, limited resources and staffing deficits within the sector.

In November 2023, it was widely reported that the Government had cut the funding for its proposed overhaul of adult social care by 58% (National Audit Office, Report – Value for money. Reforming adult social care in England (10 November 2023)). The adult social care sector in England (Research briefing: Adult social care workforce in England (14 November 2023)) is said to have a vacancy rate of approximately 9.9%, the equivalent of around 152,000 vacancies (which is higher than the NHS vacancy rate).

Balance to be struck

The CQC plays a pivotal role in maintaining standards, setting benchmarks to guarantee that care provision meets essential criteria. These standards are fundamental in ensuring quality care. Patient safety campaigners will be quick to argue that to permit a decline in standards, irrespective of the reason, would put individuals at risk. 

In addition to being undesirable, it would also be very difficult to establish how and where allowances for lack of resource should be made or taken into account - should they be allowed across every care domain or whether they be limited to a certain category. 

The CQC does consider nationally agreed measures of quality. It makes use of tools such as the capacity tracker for adult social care services and experts by experience/specialist advisors. It therefore has the ability and expertise to consider ratings in conjunction with the wider state of play. Additionally, the Factual Accuracy Check form allows providers (at Section C) to include further information which they believe should be considered as part of the rating process. This provides organisations with the ability to add greater context to the circumstances in which the service is operating.   

Conversely, organisations will say that CQC’s rigorous inspections and benchmarks, while well-intentioned, often do not sufficiently acknowledge the systemic issues stemming from the funding crisis. Providers are caught in a predicament where they are expected to deliver high-quality care within stringent parameters set out within the Health and Social Care Act, without commensurate resources and funding support.

Furthermore, the emphasis on meeting regulatory standards can inadvertently divert attention and resources away from providing holistic and person-centered care. There is a risk that providers, under pressure to fulfil CQC standards and criteria, might prioritise meeting checkboxes over addressing individual needs, thereby compromising the essence of compassionate care.

The solution 

A collaborative approach between the CQC and care providers is essential as is the need to recognise the systemic challenges faced by care providers operating with limited resources. A flexible and supportive regulatory approach, coupled with guidance and assistance, facilitates a balance between compliance with standards and the practical constraints faced by care services. 

Care providers should also not be shy about seeking out that support, opening a dialogue and working with the CQC on receipt of a draft report. It is a reality that, in healthcare, discussions around resource allocation and shortages can present a sensitive topic, especially concerning incidents or errors that lead to patient harm. Care providers, cognisant of the underlying resource deficiencies, may choose not to raise these concerns in the aftermath of an adverse event. This reticence can exacerbate the challenges faced by care providers, fostering a climate where crucial discussions on systemic deficiencies are avoided or sidelined, hindering meaningful discussion around patient safety and care quality.

Recognition of exemplary practices within resource-constrained settings is also vital. By highlighting and disseminating successful strategies, both the CQC and care providers can foster a culture of innovation and efficiency, maximising outcomes within existing limitations.

In conclusion, striking a balance between high care standards and acknowledging resource constraints requires a multifaceted approach. Collaboration, mutual recognition, innovation, and advocacy for adequate funding are indispensable elements in navigating this complex landscape. By working together in a spirit of understanding and support, the CQC and care providers can strive towards maintaining and improving care quality, ensuring the well-being and dignity of those in need of care services.