Beyond the headline finding in the Care Quality Commission’s latest State of Care report that England’s healthcare and social care systems didn’t collapse, are grim findings of increasing health inequalities, services that aren’t providing safe care, and a depleted, demoralised workforce.Front cover of CQC State of Care 2021 report

While we recognise the impact of the pandemic on healthcare and social care services, as the CQC points out throughout its report, many of the issues it highlights predate the current health emergency.  They stem, instead, from a decade of austerity and has been made worse, faster, because of the pandemic.

The difficulties this report highlights are not just a collection of individual tragedies but evidence of a failure to manage our national resources to secure the health of the population. We have said before: proper resourcing of the health and care system should be understood both as a public good and an investment in the health of the nation.

Strategic approach

We support the CQC’s call for longer-term funding, as well as funding now, for social care to enable care providers to better plan services and recruit. We also agree that new monies, including the recently announced £5.4 billion investment, should be used to enable new ways of working; this means a sustained, strategic approach across all areas that are relevant to health and social care. The NHS and the social care system are only part of the services that are essential to people’s health and wellbeing. Housing, welfare benefits, and other services all impact people’s health. Yet, it is often health and social care services that are expected to provide solutions for a patient’s problems.

The provision of social care is of huge concern to us and the CQC’s analysis of the sector is alarming. From services providing care so poor to adults with a learning disability that action is needed to keep people safe, through to care homes having to close because of lack of staff, the State of Care report paints a picture of services teeter on the verge of collapse.


We are also extremely concerned with the findings of poor care for adults in social care settings and that nearly two fifths of maternity care services need to improve safety. We agree with the CQC say when it says there’s a need for wider improvements in culture, leadership and patient partnership.  Strong leadership is especially needed at this critical moment for health and social care.

It’s been obvious to us for several months that the workforce in health and social is exhausted.  The clapping stopped a long time ago and staff working in under-resourced settings need more than a warm glow to provide high quality and safe care to patients.

As the Patients Association, we expect patients to be kept safe under all circumstances, and we include people in a social care setting in this. A key element of safety is to be cared for in first class facilities by qualified staff that are not exhausted, doing double shifts, or living with anxiety, depression, and burnout.  Even with the highest levels of personal commitment, it’s impossible not to be concerned that someone working under these conditions might make errors.  

Patient partnership

We welcome the CQC’s call for improved and widespread patient engagement and agree that new models of care are needed. We call on those who are developing these new models to partner with patients and work with the people that will benefit from new services.