CQC carries out health and social care review
"... we continue to work towards our long-held vision and priority to integrate health and social care. Our shared focus is to continue to develop services so that people in Wiltshire receive the best care available."
Jerry Wickham, cabinet member for adult social care, public health and public protection
A recent and detailed review of Wiltshire's health and social care system has found that people receiving services in the county are safe.
The Care Quality Commission is carrying out targeted reviews of health and social care in local authority areas and Wiltshire was visited on 20/21 February and 12-16 March 2018.
The review, which was coordinated by Wiltshire Council and NHS Wiltshire Clinical Commissioning Group (CCG), also included extensive data and evidence gathering from key partners in the local adult health and social care sectors. All partners involved provided information and evidence of what it's like to receive care in Wiltshire.
The CQC focused on five main questions in relation to service provision and the impact on users:
• Are they safe?
• Are they effective?
• Are they caring?
• Are they responsive to people's needs?
• Are they well led?
The final review published recognises the hard work and effort already being done by all partners to improve the care and support for Wiltshire residents, and provides useful insight into the areas where we acknowledge we must do more to improve for people in Wiltshire. Positive aspects outlined by the CQC include:
• Those who needed care and support were judged to be safe.
• The review found that there was a positive and proactive programme for the transformation of adult social care particularly around prevention, reablement and safeguarding.
• Integrated discharge teams in the hospitals worked effectively to define the pathway of care out of hospital and to begin that process.
• There was effective inter-agency working between the Voluntary, Community and Social Enterprise (VCSE) sector and hospital services in emergency departments to help people to avoid admission and return home safely.
• People were supported to stay safely at home for as long as possible through the work of GPs and care coordinators.
• There were systems in place to identify people who were frail or who were at risk of deterioration in their health or social situation.
• GPs were key in supporting people to stay safe.
• People were able to access a number of services in the community to prevent social isolation and when they came into contact with services through their GPs there was good support from them to access other services and sign-posting. They were helped to stay well at home for as long as possible.
• Avoidable admissions to hospital from care homes in Wiltshire were low compared to similar areas and the England average, and significantly lower with regard to admissions resulting from pneumonia.
• Frontline staff who provide care were recognised by reviewers for their commitment to achieving the best outcomes for people and being genuinely caring in their approach.
• Staff who supported people living in Wiltshire were caring in their approach. There was a clear will to put the person at the heart of services.
• There were systems and processes in place to ensure that people in crisis were supported through the health service.
• People using hospital services and their loved ones were treated with dignity and respect.
• People who were in crisis could access support from a variety of settings, and this was provided in a timely way. Wiltshire performed better than the England average in preventing admissions to hospital for common clinical conditions.
• There were systems and processes in place to ensure that the transition between health and social care prevented any avoidable harm.
• Acute hospitals were focused on promoting early discharges.
• There was effective partnership working to ensure that people were discharged from hospitals safely.
• People's needs and choices were considered at all stages when planning their return home.
• All services were focused on improving flow through hospitals and care, with systems being designed and redesigned according to activity and performance.
• All services had the right skills to support the effective transition of people between health and social care.
With regard to the areas for improvement or where things need to be done differently, we have already produced a detailed action plan, and a single overarching strategy will be produced to address the following areas:
• Continuing the programme of work to transform adult social care services
• Adopting national best practice and reviewing the Better Care Plan and will be adding some new initiatives that have been successful across the country
• A commitment to introduce additional Local Area Coordinators in Wiltshire by early Autumn, to support communities
• We continue to see the number of people who are medically fit to leave hospital, and the numbers of those people who are experiencing delays in getting home, is reducing
• Changes are being made which mean that the professionals who are the first point of contact to services are working together better to look at how people return home
• Creating a provider led Integrated Programme Board to review and improve the post hospital discharge pathways to include Homefirst and Reablement
• Simplifying our current complex governance structures
Jerry Wickham, Wiltshire Council cabinet member for adult social care, public health and public protection, said: "We welcome the findings of the review and we are extremely pleased that the services we provide in Wiltshire were found to be safe.
"Given the challenge for the care and health sector this is something that is good to hear and their overall feedback and fresh perspective has been welcome and has already helped to guide improvement in our partnership working and the services we provide for residents.
"The CQC's findings are very much in line with our own assessment of the local system and how it works, and, most importantly where further improvement can be made.
"Much of this work is already underway as we continue to work towards our long-held vision and priority to integrate health and social care. Our shared focus is to continue to develop services so that people in Wiltshire receive the best care available."
Dr Richard Sandford-Hill, Chairman at Wiltshire CCG said: "This is a comprehensive and realistic report and we are grateful to our staff and colleagues for their input to it. We are of course pleased that our services are considered to be safe, but we also acknowledge we still have much to do to improve our joint services on behalf of Wiltshire people. The report shines a light on those things that we need to do better or differently and has prompted us to re-energise our efforts. We are fully committed to working closely with all of our health and care partners across Wiltshire, with renewed vigour, to provide safe, high quality and seamless services for our residents."
As this was a review, and not an inspection, the system isn't subject to any overall grading or mark, but a detailed assessment on how it works has been provided.
The full report is published on the CQC website.