This report is one of 20 targeted reviews of local authority areas looking specifically at how people move through the health and social care system. The reviews look at how hospitals, community health services, GP practices, care homes and homecare agencies work together to provide seamless care for older people living in a local area.
The CQC found that there was a sense of a true partnership between health and social care services in Manchester, with partners building relationships across the system, including voluntary, community and social enterprise agencies.
Local leaders of both Manchester City Council and NHS Manchester Clinical Commissioning Group envisaged that the current challenges in health outcomes for Manchester would be addressed through the radical transformation in the integrated commissioning of care services.
However, the system in Manchester has significant problems that must be addressed in the immediate future. People’s experiences of receiving services differed across the city, there were high numbers of emergency admissions to hospital, and once people were in hospital, they were more likely to remain there for longer than they should.
Key Challenges Facing The System
- In the north of the city there were good arrangements to support people in the community to prevent hospital admission. However, once people were admitted to hospital their discharge was more likely to be delayed.
- In the centre of the city there were fewer joined-up services to prevent hospital admission, although when people were ready go home or to a new place of residence, they were less likely to be delayed.
- People who attended A&E often had to wait for more than four hours, and there were high numbers of people who had to wait for more than an hour in ambulances. This could be distressing for people who were unwell and waiting to be seen.
- People living in care homes in Manchester were at a greater risk of becoming unwell from avoidable illnesses such as pneumonia and urinary tract infections than people in similar areas.
- Care for people at the end of their lives was inconsistent; although in the north of the city there was a multi-disciplinary team to support people in their own homes, this was not available to people in the centre or south of the city and there was no hospice in Manchester to support people at the end of their lives.
Professor Steve Field, Chief Inspector of Primary Care Services, said “I know that Manchester’s political and healthcare leaders have a strong understanding of the challenges posed by poor population health, and poor health and care outcomes.”
“Our review of Manchester’s services and how they work together has found encouraging progress has been made in the establishment of joint commissioning, creating conditions for change.”
“There is a lot to do. Overall we could see there were areas of good practice in parts of the system. Where services were already integrated, staff reported that relationships between professionals such as occupational therapists and physiotherapists were good, with improved communication and information sharing.”
“We found there were workforce pressures in a number of areas, and social workers were carrying high and complex caseloads. This meant that there was a waiting list for assessments and a risk that people who were not having their needs assessed could end up as emergency cases.”
“However – the key organisations have now created a clear strategy that is built on partnership working. We found that this was clearly understood at all levels of health and social care commissioning organisations, providers and voluntary sector organisations. Staff that we met throughout the review were enthusiastic and believe that it is a force for positive change.”