The CQC has warned of the emergence an “unfair”, two-tier care system for the haves and have nots as cost pressures and low funding force an exodus from local authority funded provision.

The latest State of Care report reveals almost a third (29%) of social care providers are worried about their financial stability with over a quarter (26%) having considered leaving the sector in the past 12 months.

Local authority budgets have failed to keep pace with rising costs and the increase in the number of people needing care, the report adds.

Ian Trenholm, CQC’s chief executive, said: “The combination of the cost-of-living crisis and workforce challenges risks leading to unfair care, with those who can afford to pay for treatment doing so, and those who can’t facing longer waits and reduced access.”

The report warned: “As local authority-funded adult social care places are often less profitable, there is the risk that people who live in more deprived areas, and receive local authority-funded care, may not be able to get the care they need.”

The report reveals care home profitability at “historically low levels” in 2022/23 due to increases in non-staff costs, specifically gas and electricity price rises, as well as inflation in food and other costs.

EBITDARM in ‘specialist services’, which include supported living services and other residential and homecare services for autistic people and people with a learning disability declined consistently between September 2021 and March 2023 (by 5.1 percentage points to a profit margin of 14.6%).

The CQC said a national workforce strategy was needed to raise the status of the adult social care workforce and ensure that career progression, pay and rewards attract and retain the right professional staff in the right numbers.

Ian Dilks, chair of CQC, said Integrated Care Systems presented the best opportunity to “ensure fair care for everyone” so that “people get the care they need, not just the care they can afford”.   

Reaction

Miriam Deakin, director of policy and strategy at NH Providers said: “A long-term workforce plan for social care including better pay and support for staff would help put the sector on a sustainable footing.”

Independent Care Group chair Mike Padgham said: “Today’s report from the CQC shames us as a country and exposes the cruel, two-tier system of social care of haves and have-nots that we have been warning would come for years.

“If this continues, more and more providers who rely on local authority residents and home care contracts will fail or close down, leading to an even greater shortage of care provision. Older and vulnerable people deserve better and deserve to have the care they need, when they need it.”

Beverley Tarka, president of the Association of Directors of Adult Social Services, said:  “We need a long-term fully funded plan for social care and a commitment to paying care staff fairly to change the picture the CQC has painted in this report.”

Health and Social Care Committee chair Steve Brine MP said: “We will continue to press ministers on the Long Term Workforce Plan which must address the pressures affecting not only the staff who deliver services but the quality of care they are able to offer to patients.”

Professor Martin Green OBE, chief executive of Care England, said: “The ‘gridlock’ which characterised the health and social care system last year has been aggravated by new pressures for care, including inflation, the cost of living and ongoing challenges with the workforce. Despite 70,000 new international workers in the care sector across 2022 – 2023, resulting in a net reduction of 13,000 vacancies, we have lost 57,000 domestic workers. This is not sustainable. Without central government intervention, we may not be looking at gridlock next year, but a total impasse.”

A Department of Health and Social Care spokesperson said: “It is vital we provide patients with the level of care they expect and deserve. That’s why we are delivering on three major recovery plans to improve access to urgent and emergency, primary and elective care, and have made progress to significantly reduce the longest waits for routine treatment, despite pressures including industrial action.

“We are also investing record sums into health and social care services to improve access to care and cut waiting lists, one of the government’s top five priorities. This includes up to £8.1 billion to put the adult social care system on a stronger footing including buying more care packages, helping people leave hospital on time and boosting the workforce.

“There are record numbers of staff working in the NHS and our historic Long Term Workforce Plan will retain and recruit hundreds of thousands more staff alongside harnessing technology to reform the way we work and save staff time.”