Wiltshire: CQC publishes its review of how local health and social care systems work together

The Care Quality Commission has published its findings following a review of health and social care services in Wiltshire.

This report is one of 20 targeted local system reviews looking specifically at how older people move through the health and social care system, with a focus on how services work together. The reviews look at how hospitals, community health services, GP practices, care homes and homecare agencies work together to provide seamless care for people aged 65 and over living in a local area.

During the review CQC sought feedback from a range of people involved in shaping and leading the system, those responsible for directly delivering care, as well as people who use services, their families and carers.

The review found there was a system-wide commitment to serving the people of Wiltshire but that services had not always worked effectively together. It highlighted a number of areas where improvements are needed to ensure those responsible for providing health and social care services work better together.

• People were able to access a number of services in the community to prevent social isolation.
• Those who funded their own care sometimes had difficulty getting access to a service that suited their needs. There was a shortage of care provision to support people at home.
• When people were referred to services through their GPs there was good support to access other services and sign-posting. On the whole they were supported to stay well at home for as long as they wished.
• Health, social care and social services staff provided support in a caring way but people often had to tell their stories many times as different professionals required different assessments, rather than using a single assessment approach.
• When people were admitted to hospital there was the risk they could experience delays being discharged.
• People who were at the end of their lives were not always given priority in terms of receiving a package of care and were not always able to have their choice of the place where they would die.

Steve Field, Chief Inspector of Primary Medical Services and Integrated Care, said:

“Our review of health and social care services in Wiltshire found that although there are some high quality services available and a clear intent from the system’s leadership to improve how people move through health and social care services, the reality for people using services is inconsistent. Some older people are having a less than satisfactory experience as they move across health and social care.

“While there is care in all areas of the county for people who need it, there is a lack of a joined up system working to ensure an integrated and seamless care system for people in Wiltshire. Staff on the front line, are committed to working together however the vision for Wiltshire needs to be developed though a shared strategy to ensure people are not let down by the system.

“We have presented our findings to the new health and social care system leaders in Wiltshire so that they can prioritise and continue to improve and work together in delivering joined up care to people living in the county.”

Overall CQC reviewers found:

This review makes a number of suggestions of areas where the local system should focus on to secure improvement including:

Local system leaders in health and social care must work more effectively together to plan and deliver an integrated strategy across Wiltshire which includes an updated Better Care Plan This is a programme which seeks to provide join-up health care services so that people can manage their own health and wellbeing and live independently in their communities for as long as possible.

System leaders must resolve outstanding disputes. Systems must be put in place so that services can work together to reduce the likelihood of continuing healthcare disputes and increase the conversion rate of continuing healthcare referrals and timeliness of assessments.

Leaders must work together to develop a culture that encourages joint planning, continuous quality improvement and integrated systems to deliver care for the people of Wiltshire.

There should be better integration of areas and improved joint working to ensure effective integrated health and social care teams that meet the needs of people.

There should be contingency planning in place to manage the current purchasing framework to in-house re-ablement so that leaders are assured that there will be sufficient provision of packages of care.

Contracts with independent health and social care providers should have clear specifications and an outcome framework that is understood and agreed by providers and commissioners. Targets should be agreed and realistic, demonstrating improved outcomes for people who use services.

Ends

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