The Care Quality Commission’s annual assessment of health and social care in England shows quality ratings have been maintained overall – but people’s experience of care is determined by whether they can access good care when they need it.

While this struggle can affect anyone, a lack of access for those who are less able to speak for themselves was described as ‘especially worrying’.

The assessment found the care given to people with a learning disability or autism is ‘not acceptable’.

Chief executive Ian Trenholm said: “In this year’s State of Care, we have highlighted mental health and learning disability inpatient services because that’s where we are starting to see an impact on quality – and on people.

“There has been a deterioration in ratings in these services – and our inspection reports highlight staff shortages, or care delivered by staff who aren’t trained or supported to look after people with complex needs, as a reason for this.”

While the overall quality picture for the mental health sector, which includes community mental health services, remains stable, the CQC said this masks a real deterioration in some specialist inpatient services.

This has continued after 31 July, the cut-off point for the data included in the report.

As of 30 September 2019:

  • 10% of inpatient services for people with learning disabilities and/or autism were rated inadequate, as compared to 1% in 2018
  • 7% of child and adolescent mental health inpatient services rated inadequate (2018: 3%)
  • 8% of acute wards for adults of working age and psychiatric intensive care units (2018: 2%)
  • Since October 2018, 14 independent mental health hospitals that admit people with a learning disability and/or autism have been rated inadequate and put into special measures


“Increased demand, combined with challenges around workforce and access, risk creating a perfect storm – meaning people who need support from mental health, learning disability or autism services may receive poor care, have to wait until they are at crisis point to get the help they need, be detained in unsuitable services far from home, or be unable to access care at all,” said Mr Trenholm.

Other types of care are also under pressure.

Waiting times for hospitals have continued to increase and hospital emergency department performance has continued to get worse while attendances and admissions have continued to rise.

The CQC argues more and better community care services are needed to help people avoid crisis situations.

It also recommends care services and organisations work more closely together.

“The challenge for government, Parliament, commissioners, national organisations and providers is to change the way services work together so the right services are being commissioned to deliver what people need in their local area,” it said.

State of Care 2019 also briefly discusses the role of technology in reducing workloads and its potential impact on health inequality.

It cites Healthwatch Enfield’s report, Using technology to ease the burden on primary care, which found 63% of patients would use video calling and/or email to contact their GP to seek medical help.

The report says this kind of support is an opportunity to deliver primary care services in a new way which can ease the burden on them.

However, it also highlights the need to make sure introducing new technology does not widen the health inequality gap by only making access easier for those who can afford the right equipment or are health literate.

The full State of Care report is available to read here.