The government must immediately deliver a new deal for social care with major investment and better terms for workers, the Care Quality Commission has said, as it warned that the sector is “fragile” heading into a second wave of coronavirus infections. In a challenge to ministers, the regulator’s chief executive, Ian Trenholm, said overdue reform of the care sector “needs to happen now – not at some point in the future”. Boris Johnson said in his first speech as prime minister, in July 2019: “We will fix the crisis in social care once and for all.” But no reform has yet been proposed, and more than 15,000 people have died from Covid-19 in England’s care homes. Trenholm said Covid risked turning inequalities in England’s health services from “faultlines into chasms” as the CQC published its annual State of Care report on hospitals, GPs and care services. The report reveals serious problems with mental health, maternity services and emergency care before the pandemic, and says these areas must not be allowed to fall further behind. In routine inspections carried out before March, 41% of maternity services were found to require improvement for safety – for example, because a baby’s heart rate was being monitored in labour by staff who lacked training. More than half of urgent and emergency care services were also rated as requiring improvement or inadequate. Thirteen per cent of wards for people with learning disabilities and/or autism were rated inadequate, a sharp increase from 4% the previous year. Prof Ted Baker, the chief inspector of hospitals, said that in some cases, staff in such units did not have the right training, and that as Covid affected staffing levels, CQC had had to take enforcement action 17 times. “We are not content with it,” he said. “It’s clear sufficient progress has not been made.” The regulator argued that the health system’s response to the pandemic needs to change. After focusing on protecting NHS services from being overwhelmed, health leaders must now adapt to prevent people who need help for non-Covid reasons from being left behind, it said. These include people whose operations were cancelled and people from black and minority ethnic backgrounds, people with disabilities, and people living in deprived areas who have suffered more severely from the impact of Covid. “Covid is magnifying inequalities across the health and care system – a seismic upheaval which has disproportionately affected some more than others,” said Trenholm. In comments that will fuel debate about the need for greater devolution in the way England handles the pandemic, from lockdown rules to test and trace, the CQC stressed the need for greater local leadership of health systems. “This resetting of priorities starts with local leaders being empowered and having the capacity to respond together to the needs of their area,” it said. In social care, problems with recruiting and retaining sufficient staff, low pay and inadequate training have emerged during the pandemic. Care homes are heading into winter facing a slump in occupancy caused by deaths and a reluctance of families to send loved ones into care homes, the CQC said. “There needs to be a new deal for the adult social care workforce that reaches across health and care – one that develops clear career progression, secures the right skills for the sector, better recognises and values staff, invests in their training and supports appropriate professionalisation,” the report said. Councils and workers welcomed the call for reform. “The [government’s] upcoming spending review must urgently provide councils with the extra funding they need to help shore up social care ahead of winter, while also using this as the basis for future reform of social care,” said Ian Hudspeth, chair of the Local Government Association’s community wellbeing board. Unison’s assistant general secretary, Christina McAnea, said: “A pay and jobs boost is needed both in social care and the NHS. This would help raise morale, which is plummeting fast among workers as Covid cases soar.”