Business Opinion

2019 State of Care Report – an update on Staffing, Skills and Innovation

Deborah Nicholson is a lawyer at Markel Law

October 2019 saw the publication of the Care Quality Commission’s (CQC) State of Care report; their annual assessment of health and social care in England. The report looks at trends, shares examples of good and outstanding care and highlights where improvements need to be made.

Staffing, skills and innovation made up an important element of the report and in this piece, Markel Law’s head of regulation, Deborah Nicholson, examines the CQC’s assessment of these three issues.

Staffing and skills – an on-going challenge for operators

A stand-out theme from the CQC’s report was the challenge operators’ face in recruiting and retaining staff with the requisite skills to provide high quality care and meet regulatory requirements.

Providers are concerned about staff turnover, the difficulty in securing the right skills mix, and the level of competition that now exists when recruiting staff. This is a challenge for many operators who have struggled to retain registered managers and skilled nursing and care staff.
The most significant concerns were raised in the mental health and learning disability services. Here inspectors identified thematic issues across the sector, which is suffering from a lack of skills, training, experience and clinical support to care for patients with complex needs. It is unsurprising that in the majority of mental health inpatient services rated as inadequate or requires improvement, the lack of skilled staff featured significantly in the inspection reports.

With staffing so fundamental, any failures will impact the ratings in relation to multiple domains, particularly ‘safe’ and ‘well led’.
Some operators have sought to address staffing and skills challenges by investing in internal pathways that identify talent and develop staff to be future leaders or care specialists. Strategies of this nature are likely to be critical going forward given that the number of nurses and midwives from Europe leaving the Nursing and Midwifery Council’s register has risen from 1,981 in 2015/16 to 3,333 in 2018/19, while the number joining fell by 90 per cent (NMC Registration Data).

Innovation is critical to quality care

The CQC’s report indicated that innovation is central to many aspects of high quality care observed. Technology, for example, has been able to improve and streamline the deployment of staff.

However, it seems that technology is not being used sufficiently to improve the level of care provided in the majority of settings. Moreover, where technology initiatives have emerged, they are mainly attributable to the drive of individual leaders or from efforts made by local services.

Whilst there are examples of technology being used to improve the experience of those with protected equality characteristics, projects are often piecemeal, illustrating a lack of engagement with commissioners and providers to seize an opportunity. Clearly where funding is so stretched, particularly in adult health and social care, it is understandable that investment is often not seen as viable.

In primary care, innovative thinking has led to the development of new roles, such as advanced nurse practitioners, physician associates, social prescribing workers and nursing associates. This has helped create development opportunities in both adult social care and healthcare.

The aim is to establish the sector as a more attractive career pathway with the opportunity to develop professionally and obtain qualifications whilst at work.

The CQC’s 2019 report has highlighted very real issues for operators around staffing and skills shortages. Technology has a role to play in refining the allocation and use of resources and innovative thinking is helping to make the sector a more attractive career choice. However, with the ongoing challenges facing the sector, many fundamental issues remain.

Deborah Nicholson is a lawyer at Markel Law.


Edel Harris





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