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Government ranks areas on health/social care interface

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A league table rating performance on patient flow between the boundaries of health and social care has been published, as the Care Quality Commission announces it will continue local area reviews ahead of possible inspections of council commissioning.

The ‘NHS social care dashboard’ provides rankings on six “key indicators” of performance, including emergency admissions levels for over 65s (April 2017- March 2018), the percentage who receive rehabilitation (2016-17) and delayed days in hospital (April 2017-March 2018), which is given the highest weight in calculations.

The dashboard was updated last week but some councils have claimed the data does not reflect current performance, particularly on delayed days since March.

According to the dashboard, the top five performing areas, which is based on the geography of 150 health and wellbeing boards, are Redbridge, Wandsworth, Rutland, Wigan and Bradford. The lowest performing areas are Halton, Northamptonshire, Trafford, Stoke-on-Trent and Cumbria. 

However, Trafford, Stoke-on-Trent and Cumbria are all ranked in the top 10 for levels of delayed days per 18+ population.

Stoke-on-Trent City Council leader Ann James (Ind), who is also cabinet member for health and social care, said the data does not relate to the current situation in the area.

She added: “However, we recognise that the system is still very challenged and there is a lot of work to be done jointly by a range of partners who make up the urgent care system in Stoke-on-Trent.

“The considerable financial pressures that all the partners face remains a significant challenge.”

Hounslow has the highest rate of emergency admissions but is ranked at 25 for overall performance. Manchester has the third highest rate of emergency admissions and is ranked 144.

There is significant variation in the percentage of people over 65 who are discharged from hospital in each area and receive rehabilitation or reablement services.

In four areas – Stoke-on-Trent, West Sussex, North Somerset, York and Central Bedfordshire – less than 1% of discharged patients receive these services. Of these, Central Bedfordshire is ranked the highest at 49 for overall performance.

In five areas 7% or more patients are given these services. Hackney (8%) and Lambeth (9.4%) have the highest rate of patients receiving this support.

In a total of 19 areas, three quarters of patients or less remain at home 91 days after being discharged into reablement services.

In 30 areas, the proportion is 90% or more. The highest rate is In Rutland (97%), followed by Warwickshire (95%).

It was announced last week that the Care Quality Commission will continue its programme of targeted area reviews of the interface of health and social care following a request from the government.

Reports on the performance in three new areas - Staffordshire, Leeds and Reading – will be published by the end of the year. There will also be three follow-up visits to Stoke-on-Trent, York and Oxfordshire where weaknesses were identified.

In a letter to CQC chief executive Ian Trenholm, social care minister Caroline Dinenage said the reviews “should recognise the nationally commissioned improvement support provided to Staffordshire and Leeds”.

A CQC report following the first wave of reviews published in July said that, while some systems were working well, there is too much poor practice caused by a lack of “co-ordination and co-operation” between health and social care services, leading to “fragmented” care services.

In March former health and social care secretary Jeremy Hunt said the forthcoming social care green paper would propose an extension of the local area reviews and mooted the idea of councils being given “Ofsted-style” ratings for commissioning.

Former CQC chief executive David Behan also called for the regulator to be given more powers to inspect and rate local health systems before his departure in July.

The government is yet to formally respond to this recommendation.

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