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The coronavirus pandemic is “magnifying inequalities” in mental health, learning disabilities and social care services, which all continue to be burdened with issues around nurse staffing, inspectors have found.
The findings from the Care Quality Commission’s latest annual State of Care report for 2019-20 “should act as a wake-up call” to trigger investment in the nursing workforce, warned leaders in the profession.
“It is a concern that we are seeing worse care and there is evidence that during Covid the pressures on staffing have not helped at all in improving that”
Professor Ted Baker
The 113-page report, published today, gives an overview of service ratings in England up until the end of March before inspections were stopped because of Covid-19, and includes observations on how services coped in the early stages of the pandemic.
On the whole, the CQC said the care received in 2019-20 was “mostly of good quality” but that there was “generally no improvement overall”.
Specific areas of concern for inspectors included mental health and learning disability services and social care.
Findings showed that 71% of NHS mental health core services were rated as “good” and 11% as
“outstanding” – almost unchanged since last year’s report.
However, the overall figure masks the fact that the proportion of learning disabilities inpatient services rated “inadequate” had soared, from 4% to 13%, which was almost entirely down to deterioration in independent services.
In a press briefing on the report, Professor Ted Baker, chief inspector of hospitals at the CQC, said it was “very clear that sufficient progress has not been made to improve the inpatient care for people with learning disabilities and autism”.
“I think it is a concern that we are seeing worse care and I think there is some evidence that during the Covid pandemic the pressures on staffing have not helped at all in improving that,” he added.
The report went on to highlight that the “ongoing decline” in the number of inpatient mental health nurses continued to “add to difficulties with people accessing acute services”.
Concerns around staff shortages in mental health and learning disabilities had been at the core of the 2018/19 report.
When questioned by Nursing Times, Professor Baker said inspectors “have not seen any improvement” on the nursing workforce situation in these services since last year.
He noted that the pandemic had even heightened concerns around staffing in some units due to Covid-19-related absences.
During the early stages of the pandemic, there had been a “sharp fall” in mental health activity, noted the report, with almost 100,000 fewer referrals in April 2020 compared to April 2019.
There were also more than 2,000 fewer admissions to mental health hospitals in the same time period.
The CQC had also received reports of people with severe mental health conditions experiencing delayed discharges into community placements because of the pandemic.
Others had not had access to community placements altogether because settings such as care homes and residential schools had been closed to admissions.
The CQC had also seen an increase in calls to its helpline about or from people detained under the Mental Health Act who were distressed or confused about why they were being confined to their rooms more.
Inspectors said that although mental health activity across services had started to pick up again recently, the gaps would have “affected people’s ability to access services during this time and add pressure to waiting lists”.
“Ensuring accessible and appropriate mental health provision will be critical if the right care is to be available to those that need it,” the report said.
Inequalities were also apparent in social care services, according to the CQC, which described the sector as “fragile” because of a lack of a long-term funding solution and workforce planning.
The report noted that as of March, 80% of adult social care services were rated as “good” and 5% as
“outstanding”. Meanwhile, 15% required improvement and 1% were “inadequate”.
The CQC recognised that the virus has had a “disproportionate impact on care for older people” who were prevented from seeing their loved ones as visits were restricted in care homes.
“In social care, Covid not only exposed but exacerbated existing problems,” said the report.
The sector had been hit with “significant challenges” around access to personal protective equipment, testing and staffing, and was presented with coordinated support that was “less readily available than it was for the NHS”, it added.
In addition, the report flagged the disproportionate effect of the virus on people from Black, Asian and minority ethnic backgrounds (BAME) and the inequalities they face.
The CQC had analysed data on colorectal cancer pathways which showed patients from a BAME background and those from the most economically deprived backgrounds were at “disproportionate risk from late diagnosis and are less likely than average to access the national screening programme”.
Inspectors said this “raises questions” around whether people from these groups were “less likely to have easy access to other types of screening or early interventions, including those that might put them at greater risk from Covid-19”.
“As we adjust to a Covid age, the focus must be on shaping a fairer health and care system”
While at the start of the pandemic the focus was on acute care and protecting the NHS from becoming overwhelmed, there was now a need to “reset” priorities in health and care services to ensure “everyone, regardless of what type of care they need or where they receive it”.
“The fact that the impact of Covid-19 has been felt more severely by those who were already more likely to have poorer health outcomes, including people from Black and minority ethnic backgrounds, people with disabilities and people living in more deprived areas, makes the need for health and care services to be designed around people’s needs all the more critical,” the report said.
Commenting on the findings, Ian Trenholm, chief executive of CQC, said: “Covid is magnifying inequalities across the health and care system – a seismic upheaval which has disproportionately affected some more than others and risks turning fault lines into chasms.
“As we adjust to a Covid age, the focus must be on shaping a fairer health and care system – both for people who use services, and for those who work in them.”
Meanwhile, Andrea Sutcliffe, chief executive and registrar at the Nursing and Midwifery Council, said the report findings “reinforce the incredible pressures and our continued concerns about the unacceptable inequalities magnified by Covid-19 for people working in and receiving health and social care services”.
“From tackling the disproportionate impact of Covid-19 on people from Black and minority ethnic backgrounds, and the struggles faced by people with poor mental health or learning disabilities – to addressing the lack of long term planning and recognition of those working in social care – we’ve got to make sure our health and care workforce is supported and equipped to meet the demands of a new Covid era before it’s too late,” she added.
Key to delivering a “fairer health and care system for all” was to not only recruit but retain and develop nursing and midwifery staff “no matter where they work”.
Dame Donna Kinnair, chief executive and general secretary of the Royal College of Nursing, said the report should “act as a wake-up call” to government to invest in the nursing workforce.
“It should never be the case that people cannot access health care and these findings should set alarm bells ringing inside Downing Street,” she said, noting that even before the pandemic there were nearly 40,000 nursing vacancies in the NHS in England alone.
She added: “Services such as mental health and social care were already under huge pressures due to a lack of specialist staff.
“Covid-19 has now left them struggling to catch up.”
Meanwhile, Sean Duggan, chief executive of the Mental Health Network, which is part of the NHS Confederation, reiterated that with demand likely on the rise and “no additional resources on the horizon”, the quality of mental health services was in danger of slipping.
He added that findings around health inequalities faced by people with learning disabilities reflected the need to “improve pathways and community provision, as well as address ongoing workforce shortages”.
In response a Department of Health and Social Care spokesperson said: “We are committed to supporting our health and care services as they respond to the pandemic and continue to provide high quality care for all.”
They added that the government was “investing significantly” in mental health and that it was “looking at range of proposals to put the social care sector on a sustainable footing for the future”.