County’s integration of social care and health under fire from regulator

“Urgent and significant” improvements to health and social care integration in Cornwall must be made if the county is to tackle ongoing problems with transfers of care, a review has found.

The review, part of a new model being introduced by the Care Quality Commission (CQC), drew on data analysis and interviews with a wide range of professionals and service users. It found “poorly coordinated processes meant the experience of people moving between hospitals, social care and their own homes was often not good enough”.

Health and social care integration was a key plank of the devolution deal Cornwall agreed with the government in 2015. Over the summer, Iain Chorlton, the director of NHS Kernow, the clinical commissioning group for Cornwall and the Scilly Isles, described services in the county as being under “extreme pressure”.

Professor Steve Field, the CQC’s chief inspector of primary care services, said the new review highlighted that health and social care services in Cornwall were “not working well together”, adding that the situation was “by no means unique” to the area. Across England, delayed transfers of care have reached record levels during the past year, with large county councils witnessing particularly high numbers.

“Partnership working [in Cornwall] may be better than it has been in the past – but we have found there is little confidence that improvements will be made,” said Field. “There has been a lack of oversight and ownership to carry through change and understand what this is like for the patients.”

‘Ongoing and significant challenges’

The CQC’s review in Cornwall forms part of its 2016-2021 ‘Shaping the Future’ strategy, which commits the regulator to do more to assess service quality for population groups and consider how care is co-ordinated across organisations in an area. Three pilot reviews have already been carried out, in North Lincolnshire, Salford, and Tameside.

In Cornwall, local CQC teams had identified “ongoing and significant challenges” relating to community and adult social care provision and to delayed transfers of care. The review aimed to explore the reasons why problems were occurring and look at possible intentions.

Inspectors visited 25 independent care providers, as well as interviewing health and social care staff and leaders, GPs, and patient and voluntary groups. This process was combined with a review of existing CQC reports and national data sets.

The review found that “all relevant agencies” were working to improve joint working. But, inspectors said, “the current arrangements lacked a cohesive approach and remained fragmented and lacking in ownership, and had lost sight of the needs of people using services”.

Leaders, the review added, had no shared picture of capacity and demand in the system, while there was a “lack of confidence” among providers, staff and community groups around future integrated working.

“Many people across the system, and at all levels, told us they saw that initiatives for partnership working had started, but that they were abandoned when new staff were appointed – or where plans had been started but failed to lead to sustainable improvement,” inspectors said.

‘Not good enough’

The review concluded that people’s experience of moving between hospitals, social care and their own homes was “often not good enough”. In a series of recommendations, the CQC advised Cornwall should:

• Develop a “cohesive, visible” leadership team to take forward sustainability and transformation partnership (STP) plans
• Strengthen and clarify arrangements for inter-agency working
• Develop better engagement by leaders with staff and local communities
• “Urgently” refocus on the experience of people who move between services.

Responding to the review, Cornwall council’s cabinet member for adults, Rob Rotchell, said that the authority fully accepted the CQC’s findings.

“We apologise to the vulnerable people who have been affected by the shortcomings identified in the review,” he said. “They have a right to expect that a suitable package of care will be in place for when they are assessed as being ready to leave hospital and we have not delivered.”

Rotchell added that while some progress had recently been made in joining up services, there was still “much room” for improvement.

Sutton: ‘Improved care for older people’

In a separate review also carried out under the new regime, the CQC found that Sutton, in outer London, had “improved care for older people in care homes, reducing hospital admissions and enabling rapid and safe discharge from hospital”. The borough – one of 29 NHS ‘vanguard’ areas for health and social care reform – was selected in order to identify emerging good practice and evaluate how this could be shared more widely.

In Sutton, the CQC’s review process differed slightly from that of Cornwall but again combined data analysis with visits and interviews. Inspectors also sat in on a number of meetings in the borough, which made improving the quality of the local care sector a key element of its vanguard programme.

“In spite of an increase in care home bed numbers, there has been a reduction in A&E attendances and non-elective admissions,” the review said. “This is believed to be as a result of better coordination of care, enhanced training of care staff and better health care support for older people in care homes.”

Among their main findings, inspectors noted a “clear framework and strategic approach to collaborative working” in Sutton, with most agencies showing a “strong commitment” to partnerships.

“All stakeholders, staff and people using services that we spoke with stated that they felt included, valued and listened to,” the review added.