Poor Communication and Inconsistent Levels of Care – CQC’s Verdict Following Staffordshire System Review

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

The report is one of 23 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.

Overall CQC reviewers found:

  • Older people living in Staffordshire had varied experiences of health and social care services. There were local variations in what was available to people and consequently experiences of care and support were inconsistent.
  • There were instances of people attending A&E because they couldn’t get GP appointments and A&E attendance for people over 65 living in care homes (January to March 2018) were higher than both national and comparator areas.
  • A&E experiences were much improved at Royal Stoke Hospital.
  • Person-centered services for people with Dementia were very positively received.
  • Although there had been recent improvements, people were still more likely to be delayed coming out from hospital. There were examples of people who experienced avoidable harm due to delays in their discharge from hospital.
  • People still had a limited choice in respect of care homes rated good.
  • There were good relationships between senior leaders in the Staffordshire and Stoke Sustainability and Transformation Partnership (STP) and there was good political support from the County Council for the STP.
  • The STP struggled to communicate its vision for care to the front line.

Professor Steve Field, Chief Inspector of Primary Medical Services and Integrated Care,said: “Our review of health and social care services in the county found that older people had varied experiences of health and social care services. There were variations in what was available to them depending on where they lived, which meant that people’s experiences of care and the support they received were inconsistent.

“While there was a shared vision from leadership in the county’s Sustainability and Transformation Partnership (STP), this did not transfer to those at an operational level. This was due to a number of significant recent changes within the system, which meant more time was needed to ensure people received high quality services wherever they went in Staffordshire.

“Our review found many examples of good practice but also highlighted a number of areas where improvements are needed to ensure those responsible for providing health and social care services work better together. Some of these areas had already been recognised by the system’s leaders and plans were already being developed, or were in place, to ensure those improvements took place.

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

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

  • Though there was a clear vision and strong leadership at a senior level services delivered remained fragmented and dependent on the area of Staffordshire people lived in. A whole county joint commissioning strategy needs to be further developed so there is consistency of provision throughout Staffordshire.
  • The Health and Wellbeing Strategy for 2018- 23 should be completely inclusive and refer to how all people, including those of different faiths, beliefs, gender, sexuality, or with physical and/or learning disabilities, will be included in the development of services.
  • A whole county dementia strategy needs to be developed to ensure the needs of people with dementia are consistently supported across Staffordshire
  • The system needs to develop a strategy to ensure services are developed with input from the people who will use them.
  • Nationally validated models of GP support for care homes need to be rolled out more quickly to ensure they are ready for winter.
  • People living in Staffordshire must have equal access to services; such as the intravenous antibiotics administered in their own home and falls prevention services.
  • A system-wide approach is needed to find better solutions to manage patient discharge; such as the virtual ward, meaning people have a full range of services available to them by clinical professionals form home.
  • eLearning from serious incidents and complaints should be shared across the system.
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