A blog entry by Dr Matthew Lariviere
In October, the Care Quality Commission (CQC) published its annual report, The state of health care and adult social care in England (or State of Care). CQC is the independent regulator for health and care services in England, and its latest annual report illustrates many challenges and opportunities in delivering health and care services to support working age and older adults across the country.
I was invited by Policy Connect to attend the All-Party Parliamentary Health Group breakfast briefing on State of Care in the House of Lords. Here I highlight some of the report’s findings and share thoughts stimulated by the briefing, offering a personal reflection on how technology can support a care system in crisis.
Most (80%) of the regulated care people received in the past year was of “good” quality, with slight improvements captured across the breadth of health and care services. But this does not necessarily reflect how people experienced care. State of Care shows people did not always receive the care they needed until it was too late, when care and support needs had radically changed in the time it took to deliver the original arrangement.
People with autism or a learning disability faced particular challenges in accessing specialised care and support. Since October 2018, 14 independent mental health or learning disability hospitals had received ratings of “inadequate” and been placed in special measures, a process which means they must significantly improve their care, within a fixed timeframe, to continue operating. Even when good quality services were available, they could be located in hard to reach places, far from a person’s home.
The state of services for people with autism and learning disabilities is not an outlier. All health and care services in England are under pressure. Hospital accident and emergency (A&E) attendances and admissions continued to increase, as performance worsened across the country. July 2019 saw the highest proportion of people waiting for over four hours in any July in the past five years. And people now experience long waiting times throughout the year; it is no longer just a ‘wintertime woe’.
The stability of adult social care continues to be imperilled. An estimated 1.4 million older adults cannot access the care and support they require. More and better community care services are needed to secure individual wellbeing and system sustainability. CQC emphasises that leaders must find innovative and collaborative ways to deliver care. Many areas now have ‘joint commissioning’ governance across health and social care, but these services are not necessarily well integrated or widespread across the country.
The report nevertheless concludes that service and technological innovations may help to redress deficiencies in health and care. At the breakfast briefing, many questions centred on the role of technology in care. I share many other participants’ desire to deploy technology in beneficial ways, but know there is limited evidence that technology can be the primary solution for care systems facing existential threats arising from severe financial constraints and, locally and nationally – chronic workforce shortages.
Several years ago, a ‘Whole System Demonstrator’ trial produced mixed results with limited generalisability about the capacity for telecare and telehealth to support people with long-term conditions. We do not know how emerging digital technologies and AI (artificial intelligence) will influence health and care. Smart homes and digital technologies may offer solutions for some, but could exacerbate poor access to health and care services, particularly in rural areas. Technologies may eventually improve the efficiency of care delivery, but in themselves, and without other changes, they cannot improve the wellbeing of older people or carers [a statutory duty of all local authorities, enshrined in the Care Act (2014)], nor support an undervalued care workforce.
This year’s State of Care report should make us pause and draw breath. Let’s redefine and debate our priorities for health and care. As we evaluate the capacity of technological innovations, we should ensure the focus remains firmly on sustaining the wellbeing of older and disabled people and carers, and securing our precarious care systems – before we turn to technologies as our ‘salvation’.
In my own work as a UKRI Innovation Fellow linked to the Sustainable Care programme, I connect with entrepreneurs, designers, service providers, and policy actors exploring the potential of technology to support ageing in place. My role is to help connect their ideas and enthusiasms for new products and services to the real, everyday lives of people living with challenging conditions, such as dementia and memory problems, as well as continue to support engagement and socialisation with their families and communities. I want to see real improvements in their lives. Technologies surely have a part to play in this, but, as State of Care reports, ‘more and better community services are needed’ (p19) to address the many pressing concerns identified, before we can be confident of offering choice, pleasure and security in all their lives.
Warm thanks to Policy Connect for the opportunity to attend the State of Care breakfast briefing.