The domiciliary market is not growing fast enough to meet the increasing demand for services and offset the falling number of nursing and residential home beds, the Care Quality Commission has warned.
Speaking at the press briefing for the publication of the regulator’s annual ‘State of Care’ report, chief executive Ian Trenholm (pictured) said the adult social care system remains fragile and that the domiciliary sector is “particularly unstable”.
The warning comes despite the report showing that the number of domiciliary care services in England has grown 23% to 9,528 since April 2014.
“What [the report] is showing is a reduction in residential care as people are being maintained in their home for longer. That’s the theory. The practice though is that although the number of domiciliary care services is going upwards, we’re not convinced it’s going upwards fast enough,” said Trenholm.
“So what we are hearing from people like Age UK is that 1.4 million people in this country have got an unmet care need. What we are hearing from Carers UK is that 600 people are giving up work every day in order to look after an elderly relative.”
The number of nursing and residential homes fell 6% and 11% respectively between 2014 and 2019.
The CQC has also heard from some providers that they have had to reduce the number of available beds because they can’t recruit enough staff to care for residents. In July 2019, there were just under 36,000 care home beds in London, compared with over 52,000 people being cared for by domiciliary care agencies.
Kate Terroni, the CQC chief inspector of Adult Social Care, said that many local authorities have said in their market position statements that with the growth of extra care and good quality domiciliary care, there was less of a need to commission from the residential market. But this has created a problem in the home care sector.
“What continues to cause us concern is that we don’t think [the fall in the number of nursing home beds] has been matched by good quality and sustainable domiciliary care.”
The CQC warned that a lack of long-term funding for domiciliary services and increased challenges around the workforce is having a knock on effect on GP services and the acute sector.
“If you don’t address people’s adult social care needs, so an older person needing a little bit of extra care at home, for example, things often spiral, and when they finally present issues they are sent to the wrong place and it often ends up costing the system more money.”
Trenholm said that in order to deliver stability in the adult social care sector we need to see a long-term funding solution and innovation in the workforce.
“The innovative providers that are bringing together nurses, occupational therapists, physio therapists and other carers are the ones that are delivering the most effective care,” he said
“We also need system-wide access to workforce planning to make sure that we can attract people into the sector, retain people in the sector and move people between sectors in both health and social care. For too long, the workforce conversation in health and social care has been about health and social care as separate entities and we need to see people being able to move much more freely.
“And of course the long-term funding solution for adult social care remains vitally important to deliver stability in the sector.”