Since July 2022 I’ve been regularly reporting on care for learning disabled and autistic people that the regulator in England, the Care Quality Commission, has found to be inadequate. I have been using Twitter to share the reports, the overview findings, lowlights (they definitely aren’t highlights) and any action taken by the regulator.

I was initially also reporting on the care that they considered Requires Improvement, but there was so much of that (half of care inspected for this group this year so far – data from 1 November – has required improvement or been rated inadequate), that it became unsustainable. 

As I write this, in November 2022, I’m concerned that Twitter where I have to date done most of my reporting, is imploding. It seems a little futile right now to keep adding threads onto that platform, so instead I’ve created a new curated content section on my website where I’ll list the inadequate reports as they are published by CQC.

I’m yet to decide whether to also highlight some of the contents of the reports on my mastodon account, or how to share them. Curating the reports is a simple step, but my concern has always been that people don’t tend to open and read them – they are all routinely available on the CQC website, but it feels like the content is hidden horror, that really should be more out in the open.

For now an overview of the current ‘state’ of social care, with a specific look at care for learning disabled and autistic people, from the CQC data released on 1 November (with apologies to anyone who may have seen me share some of this on Twitter already).

There are 14,843 care homes in England, providing 453,687 beds (which we’ll shorthand to people even though they may not all be full and increasingly we’re hearing reports of care homes with empty beds because they’re unable to staff safely).

Of the 14,843 homes, 12.5% have no registered manager. This despite it being a legal requirement to have one. The registered manager and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

As for the care provided:

%	of people receiving care that is
4.5	Outstanding
70	Good
20	Requiring improvement
2	Inadequate
0.02	Insufficient evidence to rate
3.5	Not yet inspected

This suggests that 1 in 5 people are receiving sub-standard care. We should also be mindful that a CQC rating of ‘good’ isn’t necessarily what you’d expect either. Good means that all required standards are met, it doesn’t mean that anything exceptional is happening.

If we just rely on this overall, somewhat historic data we’re not getting a current picture because 70% of care homes have not been inspected since 2020. Which to my mind feels like a lot of historic ratings and a considerable amount of optimism.

If we dig into the data further, and look at the 30% of all care homes that have been inspected in 2021 and 2022, how does the picture change? Short answer, it paints a much more bleak picture.

Let’s start by looking at this year, to date, 2022.

There are 2,637 inspection ratings are available, covering 96,164 beds. What care do people receive?

%	of people receiving care that is
0.6	Outstanding
49	Good
42	Requiring improvement
8	Inadequate
1	Insufficient evidence to rate

Take that in a minute.

Half the people receiving social care in care homes inspected this year so far, are deemed to receive care that does not meet minimum standards. Less than 1% of people are receiving care that is outstanding, and I’m certain that if it were care for ourselves or our loved ones we’d want them to receive outstanding care.

What about care for “Service user band: learning disability or autistic spectrum disorder”, is that the same?

On 1 November there were 5,313 care homes in England, providing 64,362 beds to learning disabled and/or autistic people. Of those 12% have no registered manager (642 homes).

How does care look? Well let’s start with the overall picture, including historic data.

%	of people receiving care that is
4.7	Outstanding
74	Good
17	Requiring improvement
2.6	Inadequate
0.02	Insufficient evidence to rate
1.6	Not yet inspected

So again, 1 in 5 people were receiving substandard care.

However, if we look under the optimism cloak and explore recent ratings for care homes for learning disabled and autistic people. Is it much different?

There have been 737 ratings published so far this year, covering 10,976 beds (or people in their homes). Resulting in a much, much less positive outlook.

%	of people receiving care that is
0.4	Outstanding
41	Good
44	Requiring improvement
14	Inadequate
0.2	Insufficient evidence to rate

58% of learning disabled and autistic people living in care homes in England inspected this year, are not receiving care that meets minimum standards.

58%

I know that some people will read this and immediately jump to the fact that the regulator, the Care Quality Commission have changed to a more proactive approach to regulation recently, visiting when they’re alerted to concerns, not just regular routine inspections.

According to this July update that changed was planned from last month:

“We will not rely on set piece inspections, scheduled based on a providers’ previous rating”

So that change is unlikely to have kicked in yet, but in the spirit of balance I went back to 2021 as well.

In 2021, there were 1,725 ratings published across social care, covering 66,900 beds. Of those, 434 ratings were published for care homes for learning disabled and/or autistic people, covering 7,481 beds.

How did inspectors rate the care provided?

% of all people	receiving care that is	% of learning disabled/autistic people
1	Outstanding	1.3
60	Good	57
38.5	Requiring improvement	40
0.3	Inadequate	1

Smaller number of inspections than this year to date, and 40% of all people’s care, slightly more 41% of learning disabled/autistic people’s care, not meeting minimum standards.

I couldn’t help but meddle further and look at the data relating to charitable care for learning disabled and autistic people. It appears if you look even further under the optimism cloak an even more grim picture emerges. Who do we hear from when social care is covered in the media? Charities. Who holds the ear of politicians and policy makers? Charities. Who are claiming to further advance the rights of learning disabled and autistic people, while also providing shockingly poor care? Charities.

There’s a caveat here, in that CQC data only records providers with a charity number, so it doesn’t include the not-for-profit charitable registered societies and housing associations who still benefit from charitable tax relief etc. Which means that some providers operating as charities are not included here.

Of 5,313 care homes for learning disabled and/or autistic people, 1,052 are provided by charities (more will be, but that’s those with a charity number).

That’s 20% of care homes for this group. 1 in 5 of all homes.

The 1,052 homes provide 11,290 beds.

I would hope that charitable care, with all their ambitious statements, catchphrases and claims of their transforming the lives of disabled people, are going to be providing brilliant care, aren’t they? Many of the same people lobbying government and taking up space? Surely they lead the way?

102 ratings into charitable care homes for learning disabled and autistic people so far this year.

%	of people receiving care that is
0	Outstanding
42	Good
43	Requiring improvement
16	Inadequate

Not one charitable provider rated outstanding, 16% inadequate and 59% of care not meeting minimum standards.

2021 I hear you ask? There were 60 reports published last year into charitable care homes for learning disabled and autistic people

%	of people receiving care that is
0	Outstanding
55	Good
43	Requiring improvement
2	Inadequate

Again, not one outstanding home. 2% inadequate and 45% of care not meeting minimum standards.

Why are charities providing care at all, if not to set the standard? To inspire? To create outstanding examples for others to follow. Yet we actually see that they are providing less well than other providers.

And if we zoom back out to all social care homes from charities, it’s just as bleak. In 2022 so far there have been 206 ratings published, which equates to 5,611 beds.

%	of people receiving care that is
0	Outstanding
44	Good
42	Requiring improvement
15	Inadequate

In 2021, 135 ratings were published into charitable care homes, that’s 4,423 beds

%	of people receiving care that is
0	Outstanding
64	Good
36	Requiring improvement
0.1	Inadequate

Not one charitable care home rated outstanding in the last two years. Not one.

If we look at the overall state of social care using CQC data, while concerning, I think its painting far too optimistic a picture, because so many services are relying on old ratings and haven’t been inspected in years.

Things are bleak, and appear to be getting bleaker. I know there is a lot of noise at the moment about a ‘social care crisis’, a not insignificant amount being made by the same charitable providers who are providing sub-standard care to disabled people.

However if you dive deeper, open up the CQC inspector’s reports a far more complex picture emerges. There are of course challenges on budgets and staffing, but there is an awful lot not related to money or staffing per se.

Report after report after report highlights poor leadership and values, or the complete absence of leadership. The absence of meaningful systems for providing safe care or auditing it, instead a reliance on performative scrutiny. The poor building stock, and most of all the lack of humanity, kindness or compassion.

Poorly paid staff, shown little respect or leadership by employers, left with an expectation that they themselves will in turn somehow treat the people they’re paid to support with the care and compassion that they are missing themselves. It’s really no surprise things are so bad, and getting worse.