The CQC’s annual pulse check of the state of social care published this month graphically exposes the emergence of a ‘two-tier’ care system of ‘haves and have nots’.

Almost a third (29%) of social care providers are worried about their financial stability, with over a quarter (26%) having considered leaving the sector in the past 12 months, the report states.

The report reveals care home profitability at “historically low levels” in 2022/23 due to increases in non-staff costs, specifically gas and electricity price rises, as well as inflation in food and other costs.

EBITDARM in ‘specialist services’, which include supported living services and other residential and home care services for autistic people and people with a learning disability, declined consistently between September 2021 and March 2023 (by 5.1 percentage points to a profit margin of 14.6%).

These financial pressures are driving an exodus of care providers from local authority care provision and creating a society of ‘haves and have nots’ where people in deprived areas are not able to access care.

With more than 70% of care home residents state funded in the Northeast compared with just over 50% in the Southeast, a North-South divide in care quality and access is becoming increasingly embedded.

In a letter to the chancellor this week, the Local Government Association warned of a system on the brink of collapse, predicting a £4 billion budget shortfall over the next two years.

The number of people waiting for a care assessment, a care review or for their support or direct payment to start stood at over 430,000 as of March 2023, including over 80,000 people who have been waiting over six months, with a 17% shift to unpaid carers between 2011 and 2021 being driven by people with high needs who would have in the past accessed care services.

The growing inequality of health and social care provision revealed by the CQC exposes the urgent need for fundamental reform.

The CQC highlights the need for social care national workforce strategy to sit alongside the NHS Long Term Workforce Plan.

Additionally, there remains the urgent need for long-term funding reform of social care so that those who can afford to save to pay for their own care do so, while those who cannot are given adequate support by the state. A national fair rate for care must also be funded by government so that offering publicly funded care remains sustainable for providers.

A civilised society should be judged on how well it looks after its most vulnerable and deprived. Urgent measures are required if we are to not fail that test.

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