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Chief inspector warns DTOC rows 'fracturing' health and care relationships

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Mounting tensions between local government and the NHS over delayed transfers of care could hinder improvements to services, the Care Quality Commission’s chief inspector of social care has warned. 

Andrea Sutcliffe told delegates at the National Conference of Children and Adult Services today that councils should be more “assertive” as “leaders of local systems” and develop stronger relationships with health partners in order to help them understand the impact of local politics when developing joint strategies.

When asked by a delegate for her view on whether targets for reducing delayed transfers imposed on councils by NHS England could undermine existing plans developed locally, she said: “I am kind of worried about the impact of some of the debate and dialogue that is happening at the moment and has been evidenced in many of the sessions that we have had at this conference.

“I have never heard so much commentary about either delayed transfers of care or relationships with the NHS than I have done in the last 24 hours. What I am worried about is that there is a heightened level of tension and the potential for relationships to become fractured.”

She earlier said that councils play an important role in bringing partners together but she had sensed a tendency for some delegates to feel inferior to their NHS colleagues.

Ms Sutcliffe added: “There is something for local government around asserting yourselves in that space rather than some of the conversations we were having over that last 24 hours of local government feeling a little bit like little brother or little sister to the health service. With the best will in the world, there was always going to be that tension.”

She added that there was a lack of “appreciation” from some people in the NHS about the impact of local politics and said developing relationships focused on the importance of improving outcomes for service users could help local health leaders “understand what is driving political priorities”.

“It is much better to be having conversations around the table rather than people chucking missiles at each other,” Ms Sutcliffe added.

The CQC today published the findings of its first local system review of the interface between health and social care in Halton.

It said the health and wellbeing board would “benefit from more vigour in calling system leaders to account to ensure improvements are delivered “at pace”.

The CQC added the vision of Halton MBC and local clinical commissioning groups should be more “cohesively aligned” with the wider sustainability and transformation plan through shared performance metrics and joint governance arrangements.

The report also said that commissioning by Halton and the CCGs would benefit from increased engagement with NHS trusts, while strategies to reduce delayed transfers of care “should continue at pace”.

Introducing the findings, Ms Sutcliffe apologised that the timeframe for the review was “very pressured”.

She also said some changes had been made to processes and communication since the review.

During the session Halton director of adult social care Sue Wallace-Bonner likened the review to a “fast roller-coaster” and said it was too focused on council performance.

“There have been some changes to process but it still felt like an inspection; it felt like we were done to rather than working together with the CQC,” she added. 

Ms Wallace-Bonner said 13 CQC reviewers visited the council during the review period.

“That was quite a challenge for us – the fact we had more reviewers than we had managers in our area provided us with quite a difficulty in trying to arrange meetings,” she added.

Ms Wallace-Bonner also said that while the review had provided a good opportunity to receive an external assessment of arrangements, a meeting with CQC beforehand would have provided an opportunity to agree “key lines of enquiry” to enable a “deep dive into existing challenges”.

Ms Sutcliffe accepted that the reviews are “very much crisis episode focused” and may not pick up “those areas where the struggles are happening elsewhere [in the system]”.

The government announced reviews of 20 health and care systems in March. The CQC have now completed three and an interim report is due to be published by Christmas following the completion of 12 reviews, with a full report due next year.

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