COVID-19 magnified inequalities in primary care, says CQC report

The COVID-19 pandemic has helped to highlight inequalities in health and social care, according to the Care Quality Commission (CQC)The COVID-19 pandemic helped to highlight inequalities in health and social care, according to the Care Quality Commission (CQC).

In its newly-released annual report, the watchdog calls for the focus to shift towards a care system that delivers for everybody.

Even before the onset of the pandemic, it concludes care was good – but with ‘little overall improvement’. For example:

  • In the NHS, improvement in certain areas was slower than others. This includes maternity, mental health and emergency care. More than half of urgent and emergency services were rated as requires improvement or inadequate at of 31 March 2020
  • A lack of long-term funding meant the social care sector was fragile
  • In mental health services, inspectors continued to find poor care in inpatient wards for those with autism and/or learning difficulties
  • The ratings of most primary medical services remained unchanged.

Impact on dental care

In terms of dental care, the report states there were ‘significant gaps’ in access prior the pandemic.

But now, it states it is likely to be ‘some time before full capacity is reached’ after practices had to scale back to accommodate fallow period requirements.

Key findings on how the dental profession was impacted by COVID-19 include:

  • PPE being a ‘huge challenge’
  • General concern that national messaging could have been more timely and effective
  • When looking at system-wide governance, oral health in most areas ‘was not seen to be an integral part of the system’
  • Dental providers were proud of staff and their ability to adapt to a new way of working.

Reset priorities

Following the start of the pandemic, the health and social care sector had to adapt and develop new ways of delivering services.

Now, the CQC is calling on these developments to continue – whilst making sure nobody is worse off in the process.

‘This resetting of priorities starts with local leaders seizing the opportunity to collaborate and building capacity to respond together to the needs of their area,’ it states.

‘The fact that the impact of COVID has been felt more severely by those who were already more likely to have poorer health outcomes.

‘This includes people from black and minority ethnic backgrounds, people with disabilities and people living in more deprived areas.

‘This makes the need for health and care services to be designed around people’s needs all the more critical.’

It also states the impact on NHS elective, diagnostic and screening work is ‘enormous’. Life-changing operations are yet to be rescheduled, for example, and cancers have been left undiagnosed and untreated.

Maintain momentum of transformation

‘Pre-COVID, the health and care system was often characterised as resistant to change,’ Ian Trenholm, chief executive of CQC, said.

‘COVID has demonstrated this is not the case. The challenge now is to maintain the momentum of transformation. But to do so in a sustainable way that delivers for everyone – driven by local leadership with a shared vision and supported by integrated funding for health and care.

‘There is an opportunity now for government, parliament and health and care leaders to agree and lay out a vision for the future at both a national and local level.

‘Key to this will be tackling longstanding issues in adult social care around funding and operational support, underpinned by a new deal for the care workforce. This needs to happen now – not at some point in the future.

‘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.’

As of 31 March 2020:

  • 76% of community dental services were rated as good and 18% as outstanding (31 July 2019: 73%, 19%)
  • 80% of adult social care services were rated as good and 5% as outstanding (31 July 2019: 80%, 4%)
  • 89% of GP practices were rated as good and 5% as outstanding (31 July 2019: 90%, 5%)
  • 67% of NHS acute core services were rated as good and 8% as outstanding (31 July 2019: 65%, 7%)
  • 71% of NHS mental health core services were rated as good and 11% as outstanding (31 July 2019: 71%, 10%).

The full report can also be read here.

Author’s analysis

It’s clear NHS services were not up to scratch even before the pandemic hit the UK, making it all the more important that health and social care is looked after.

As the report highlights, the system has to be shifted to eradicate inequalities.

But as the CQC rightly point out, one thing that can be taken from the pandemic is that it’s shown how sectors are able to adapt and adjust.

The next few months will be a critical time to ensure the healthcare system doesn’t slip into a state worse than it already is.

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