| Our annual assessment of the state of health care and adult social care in England has published. State of Care looks at the trends, shares examples of good and outstanding care and highlights where care needs to improve. "This year has been a turbulent one for health and social care. In addition to the ongoing problem of 'gridlocked' care highlighted in last year's State of Care, the cost-of-living crisis is biting harder for the public, staff, and providers - and workforce pressures have escalated. This combination risks leading to unfair care - where those who can afford to pay for treatment do so, and those who can't face longer waits and reduced access." 
Ian Trenholm, Chief Executive, CQC
Ian Dilks, Chair, CQC
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 Problems with people's access to care in England is an enduring issue that we have raised in successive State of Care reports. Getting access to services remains a fundamental problem, particularly for people with protected equality characteristics. Along the health and care journey, people are struggling to get the care they need when they need it. We highlight issues relating to record numbers of people waiting for planned care and treatment and ongoing struggles with getting GP and dental appointments. Once at hospitals, people are facing longer delays in getting the care they need, and insufficient capacity in adult social care is continuing to contribute to delays in discharging people from hospital.  The quality of care that people experience is affected by many different factors. Increasing demand and pressures on staff are taking a toll on their mental health and wellbeing. Many people are still not receiving the safe, good quality maternity care that they deserve, with issues around leadership, staffing and communication. Ingrained inequality and the impact on people from ethnic minority groups remains a key concern. The quality of mental health services is an ongoing area of concern, with recruitment and retention of staff still one of the biggest challenges for this sector.  We spoke to midwives from ethnic minority groups, who told us that care for people using maternity services is affected by racial stereotypes and a lack of cultural awareness among staff. People from ethnic minority groups who had a long-term condition felt they were talked down to about their treatment and were not treated as individuals. They also said a lack of cultural competency was a barrier to receiving good quality care. In supported living services, failures in the system and a lack of funding can mean that budgets are prioritised above truly person-centred approaches in support.  There are ongoing problems with the current DoLS system that have left many people who are in vulnerable circumstances without legal protection for extended periods. In 2022/23, the number of applications to deprive a person of their liberty increased to over 300,000, with only 19% of standard applications completed within the statutory 21-day timeframe. Delays in implementing the Liberty Protection Safeguards mean these challenges are likely to continue.  Staff regularly fed back to us that they are being overworked, are exhausted and stressed - sometimes to the point of becoming ill, injured or leaving their job altogether. They say this can affect their ability to provide safe and effective care to people. Just over a quarter (26%) of NHS staff were satisfied with their level of pay. In adult social care, many providers are struggling to pay their staff a wage in line with inflation. In 2022/23, approximately 70,000 people arriving to work in the UK from overseas started direct care roles in the independent adult social care sector, compared with around 20,000 in 2021/22. Providers of adult social care services have told us that recruiting staff from overseas has enhanced the diversity and skills of their team and helped resolve staffing issues. But there is a growing trend of unethical international recruitment practices. In 2022/23, we made more than 4 times the number of referrals for concerns regarding modern slavery, labour exploitation and international visas than in 2021/22.  The way health and social care works in England has changed significantly over the past year, with new integrated care systems now formalised. Local systems should now implement plans to address unwarranted variations in population health and disparities in people's access, outcomes, and experience in health and social care. Local authorities are tackling workforce problems in adult social care and trying to address gaps in care as they plan for the future. But they will need to demonstrate an understanding and preparedness for the changing and complex needs of local populations. Assessing carers' needs is vital. Carers, including unpaid carers, are a critical part of all local care systems and they are not always getting the support they need - there is variation across the country and many carers are facing financial problems. | 
