Fears over safeguarding and the adequacy of staff training mar a picture of steady improvement in care services, the Care Quality Commission has said.
In its first annual State of Health Care and Adult Social Care in England report, the regulator says rising demand and pressure on finances will make reform inevitable.
The report highlights a steady increase in the number of authorities performing “well” or “excellently” as defined by December’s annual performance assessment, which showed 95 per cent of authorities in those categories.
But it says 10 per cent of councils need to make improvements in their safeguarding procedures and notes that staff training and qualifications are considered a strength in only 16 per cent of councils.
Only 13 councils are performing well in workforce recruitment and retention, it adds.
CQC interim chair Dame Jo Williams said that despite successes in reducing hospital infection rates and helping people live independently at home “pockets of poor practice” remained in health and social care.
She said increasing demand and rising expectations would be “exacerbated by pressure on finances” that would force radical changes.
“This means shifting the culture away from a one-size-fits-all approach to care that puts the needs of individuals and carers at the centre of everything,” she said.
“A key part of this will involve helping people maintain their independence and health.”
Elsewhere, the report remarks that 72 per cent of councils now ration their funding for social care to people whose needs are “substantial” or “critical” according to the fair access to care services criteria.
It also notes a drop from 241,000 to 208,5000 in the number of people being supported by councils in care homes between 2009 and 2005, and suggests this is evidence of more people being helped to live at home.
Despite this, the CQC notes that national figures mark wide local variation in the use of council-funded nursing and residential care, which does not reduce substantially when relative levels of deprivation are brought into consideration.
The report also points to a near doubling of people with access to services aimed at preventing their admission to hospital over the same period.