The Care Quality Commission has published its findings following a review of health and social care services in Leeds.
This report is one of a number of 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 Leeds review, undertaken in October, followed a programme of 20 reviews carried out between August 2017 and July 2018. 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.
The report concludes that system leaders in Leeds had a shared vision that was supported and understood across health and social care organisations, with a shared understanding of the challenges ahead.
Reviewers found that there was a good voluntary, community and social enterprise sector in Leeds with many opportunities for people to receive support, particularly for people at risk of social isolation and loneliness.
The review found that when older people attended hospital, there was a higher chance than the England average that they would be admitted, and once people were admitted it was difficult for them to return home with support. The review team also found that some people had poor experiences when they were in hospital. For example, the Clinical Decision Unit based in St James’s Hospital was being used as a medical admissions unit due to a lack of capacity on the wards.
When people were due to return home, the discharge process was not always well-planned or coordinated. Discharges could take place at inappropriate times of day and people did not always have access to the medicines or transport that they needed.
Alison Holbourn, CQC Deputy Chief Inspector for Primary Medical Services, said:
“Overall we could see that the main organisations that are responsible for planning health and social care services in Leeds have put in place structures and shared agreements that will permit the system to develop.
“Although the statutory authorities work well together, some GPs and social care providers were not so closely involved – even though there is potential for them to help shape the system and so improve the health and care experience of people living in Leeds.
“We found that the pressure on the system was most apparent in the flow of patients in hospital, where the shortage of suitable nursing care home places meant that people were often waiting to be discharged – putting further pressure on beds. To move forward It will take all parts of the system, including social care, GP surgeries and the voluntary sector to play their part in finding solutions and integrating care.“
The review found there were some areas of good practice. In response to delayed discharges and the pressure of bed occupancy some initiatives were put in place, such as the provision of 227 community care Beds in eight sites across the city.
Potential areas for improvement including:
- System leaders should continue the work to reduce hospital admissions as admissions are higher than the England average. There should also be consistent and proactive input enabled from GPs to support this.
- Specific pilot schemes were helping people to receive support in the community. There should be evaluations and exit plans in place to reassure or inform people who benefitted from good support about what their future options were
CQC has presented its findings to the health and social care system leaders in Leeds so they can continue to work together and focus their efforts to improve the delivery of joined up care for all people living in the city.