State of Care 2019/20

Key points

• The care that people received in 2019/20 was mostly of good quality
• However, while quality was largely maintained compared with the previous year, there was no improvement overall
• Before the arrival of the coronavirus pandemic, we remained concerned about a number of issues:
  • the poorer quality of care that is harder to plan for
  • the need for care to be delivered in a more joined-up way
  • the continued fragility of adult social care provision
  • the struggles of the poorest services to make any improvement
  • significant gaps in access to good quality care, especially mental health care
  • persistent inequalities in some aspects of care

Key points

• As the pandemic gathered pace, health and care staff across all roles and services showed resilience under unprecedented pressures and adapted quickly to work in different ways to keep people safe.
• In hospitals and care homes, staff worked long hours in difficult circumstances to care for people who were very sick with COVID-19 and, despite their efforts to protect people, tragically they saw many of those they cared for die. Some staff also had to deal with the loss of colleagues to COVID.
• A key challenge for providers has been maintaining a safe environment – managing the need to socially distance or isolate people due to COVID-19. Good infection prevention and control practice has been vital.
• The crisis has accelerated innovation that had previously proved difficult to mainstream, such as GP practices moving rapidly to remote consultations. The changes have proved beneficial to, and popular with, many. But many of these innovations exclude people who do not have good digital access, and some have been rushed into place during the pandemic.
• The pandemic has had a major impact on elective care and urgent services such as cancer and cardiac services, and there is huge pent-up demand for care and treatment that has been postponed.
• The pandemic is having a disproportionate effect on some groups of people, and is shining a light on existing inequality in the health and social care system. It is vital that we understand how we can use this knowledge to move towards fairer and more equitable care, where nobody’s needs go unmet.
• It is important that the learning and innovation that has been seen during the pandemic is used to develop health and social care for the future. New approaches to care, developed in response to the pandemic and shown to have potential, must be fully evaluated before they become established practice.

Key points

• The success of collaboration between provides to keep people safe was varied, often affected by the maturity of pre-existing relationships within the system.
• Understanding the needs of local populations, including cultural differences, was especially important.
• Sectors did not feel consistently engaged in the coordination of responses to the crisis.
• Health and social care staff worked above and beyond, with a shared drive to look after people well and keep them safe.
• System areas benefitted from the pace of effort to secure a regional level grip across communication, support and joint working approaches in response to confusion from the pace of national guidance.
• The voluntary sector played a critical role in supporting health and social care to keep people safe. System-wide leaders were concerned about capacity to meet the demands of subsequent peaks without this support.
• Where we found well planned governance, clear decision-making arrangements and escalation plans, those system-wide responses were most effective.
• Areas with sector and pathway oversight cells secured increased communication, timely information sharing and collective partnership decisions.
• Where we found multiple or unclear governance arrangements, those areas experienced higher levels of confusion and duplication of effort.
• The engagement of all sectors to system level responses varied. Where there was less engagement, there was a disconnect between communication and information within and across providers.
• Views of sector partners varied as to the effectiveness of joint and supportive working arrangements, particularly between care homes and GP practices.
• Strategies to manage staff and resources across sectors and partnerships were inconsistently navigated, causing varied success of collaboration within systems.
• Initiatives to manage professional skills capacity across providers was managed well in some areas, with demonstrable impact.
• A wide range of measures were introduced to keep staff safe, although implementing them caused challenges.
• Accelerated and shared digital approaches supported providers to work together and keep connected well.
• Advanced IT and technology did not always assist with efficient and timely access to care for people.
• At times the pace of change felt overwhelming for health and social care providers.

Key points

• The problems that existed before COVID-19 have not gone away.
• The fact that the impact of COVID has been felt more severely by those who were already likely to have poorer health outcomes makes the need for services to be designed around people’s needs all the more critical.
• There needs to be a new deal for the adult social care workforce that reaches across health and care – one that develops clear career progression, secures the right skills for the sector, better recognises and values staff, invests in their training and supports appropriate professionalisation.
• Primary care services need to make sure that people and patients are given the confidence to interact with them early, provide a range of ways for people to access the care they need, and to make it easy for them to do so.
• The increased waiting lists and backlog of urgent and elective care need to be addressed – services need to assess and prioritise patients so that they are treated according to clinical need and that people waiting for long periods for treatment are kept safe.
• We must use the learning from the pandemic to lock in positive changes, and drive a new way of working that is supported at a national, regional and local level by the whole health and care system.

Coming together to ensure people continue to get the care they need

Val and Peter are a married couple in their eighties. Peter has motor neurone disease, and Val has been his main carer for the nine years since his diagnosis. In the past three years, as Peter’s condition has worsened, he has been unable to leave their home. Peter is now paralysed from the neck down, and needs a ventilator to help him to breathe.

Val and Peter are supported by carers who visit three times a day, a specialist hospital in London, a local motor neurone disease specialist nurse, their GP and pharmacy, district nurses, and the Motor Neurone Disease Association charity. Val told us that, when pandemic lockdown measures were introduced, she expected that some of this support might change or fall away.

Instead, support has continued for both Val and Peter. The care agency has managed to make sure that the same carers attend to help Peter with personal care, which is important to him as some of this – such as bathing – is very intimate. The only change has been in the PPE that they must now wear. The specialist nurse, who used to visit them monthly, now contacts Val and Peter on the phone to check in and make sure they have everything they need. Their GP has also provided remote appointments, and the pharmacy is continuing to deliver medicine to their home.

Support groups provided by the Motor Neurone Disease Association have moved to Zoom, which Peter can access on a specialised computer and which he operates with an eye-tracking device instead of a mouse and keyboard. This has been an improvement for Peter as, despite technical issues, he has been able to attend for the first time since he stopped leaving the house.

Val works hard to provide Peter with care, and while lockdown has not changed this, the couple are hoping to arrange some respite care for Peter during the week. This would mean Val could leave the house for longer periods to socialise, without worrying about Peter or having to frequently check her phone.

Having the consistent support of health and social care services has lessened the impact of the pandemic on Val and Peter, and the couple are very appreciative of the help they receive.