The Care Quality Commission has called on leaders of the organisations that oversee the provision of health and social care in Cornwall to join forces and work together to ensure that people get the services they need as they move through the system.
A review that focused on how different parts of the health and social care system work together found poorly coordinated processes that meant the experience of people moving between hospitals, social care and their own homes was often not good enough. The review has concluded that the services need to make urgent and significant change to improve.
The different parts of the system are not working together to ensure people can move between services as they need them. Too many patients are stuck in hospital waiting for the support they need to live at home, or trying to find a place in a care home. Some people are living in care homes when they could be in their own homes, supported by social care.
The report concludes that:
- All the relevant agencies have been working to improve the systems and processes to support inter-agency working. But the current systems lack a cohesive approach and remain fragmented, lacking in ownership and having lost sight of the needs of people using services.
- People’s experience of moving out of hospital and to a care home or home with social care support is often poor.
Although agencies were working to improve joint working, they did not have a clear shared picture of the demand and capacity of social care services.
CQC’s analysis showed there was a higher rate of delayed transfers of care in Cornwall than in similar areas, with delays attributable both to the NHS and adult social care.
The report says there are a number of plans to improve how the system works together but these not presented as a cohesive collaborative plan with clear purpose and vision by all system leaders.
Systems for discharging people from the Royal Cornwall Hospital to ongoing health and social care were confusing, with no strategy for agencies to work together. A comprehensive external review had reported in 2016 - but there was no plan to implement the recommendations. Local GPs told inspectors that there was a lot of talk about integration, but little evidence of change.
Care home staff told inspectors about people being discharged from hospital without important information about their treatment or ongoing needs... although inspectors were also given examples where local community hospitals were supportive and responsive.
Some patients were moved to care homes or hospitals because there was no support available in the community - whether from district nurses or care workers.
People who had recently been discharged from hospital said there was little choice of care home or of domiciliary care agency. Patients had to take what was available – even, in the case of care homes, if that meant friends or family could not visit easily.
Professor Steve Field, Chief Inspector of Primary Care Services, said:
“Our review has identified that the health and social care system in Cornwall is not working well together. The experience for patients who need to leave hospital but require ongoing care is poor.
“Partnership working may be better than it has been in the past - but we have found there is little confidence that improvements will be made. There has been a lack of oversight and ownership to carry through change and understand what this is like for the patients.
“This is by no means unique to Cornwall. Across the country NHS and social care services are coming together to identify ways of providing care more flexibly and efficiently to meet the needs of our ageing population.
“It is more important than ever that local authorities, social care providers and their NHS colleagues in acute, community and primary medical services work together in mature, purposeful and trusting relationships.
“If they can achieve that - there is every chance that the communities those organisations serve will be provided with good quality care. And that's vital for all those people living with long term conditions who may need to move between health and care services as their needs change.”
The report identifies five areas for improvement:
- The system leaders must focus on building and presenting a cohesive, visible leadership team with a full time leader to take forward the sustainability and transformation plans.
- Arrangements for interagency working must be clarified, strengthened, and consistently implemented. System leaders responsible for commissioning and delivering care should set out and communicate widely their agreed framework, structure and governance
- Leaders must re-engage with the community and staff and establish a programme of co-production across the area to better understand the problems, and involve staff and public to agree on priorities.
- There is an urgent need to refocus on the experience of people moving between services who need ongoing support.
- All recommendations must have an accountable person or group to oversee action, implementation, monitoring and evaluation.