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CQC: City's care system putting older people 'at risk'

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The health and wellbeing of older people in Stoke-on-Trent is being put at risk by poor joint working between the council and clinical commissioning group, the Care Quality Commission has found.

In a highly critical review of the city’s health and social care system, published this morning, the regulator said better collaboration was urgently required in order to improve services and prevent people from requiring unnecessary acute hospital care.

CQC inspectors visited the city as part of a programme of 20 reviews of health and care systems order by the health and communities secretaries earlier this year.

They were unable to find either a shared vision for services or evidence of ‘whole system’ strategic planning and commissioning. These problems meant many older people had to stay excessively long in hospital before they could be moved into care, the report said.

Inspectors also found there had been “very ‘siloed’ working across the system coupled with cross-organisational tensions… particularly evident in relation to the local authority and the CCG”.

The report said these poor relationships were exemplified by poor winter planning and a failure to sign off the better care fund arrangements by the deadline.

“System leaders were not transparent with regard to financial arrangements and this lead to a breakdown in joint working. This posed a significant risk to the health and wellbeing of older people living in Stoke-on-Trent,” the report said.

Stoke-on-Trent City Council’s city director and the CCG’s accountable officer were “now personally committed to working collaboratively”, the report said. However, numerous changes in leaders across the commissioning and secondary care system in recent years meant the area had lacked a “period of stability… to enable relationships to embed”.

Professor Steve Field, chief inspector of primary medical services and integrated care, said: “It is quite clear that some older people in Stoke-on-Trent have suffered a poor experience of care - because the local health and social care services have not been working together effectively.

Prof Field said there was enthusiasm to change, but those concerned “did not have clarity about how to achieve this”.

The report also criticised local oversight of the care home market, which it said lacked a strategy for managing quality unless providers were in crisis. It also criticised the community services provider for closing community beds without consulting social care leaders about the impact and reported concerns that a health provider’s decision to commission its own domiciliary care had destabilised the market. In response the council had increased its own in-house provision but it was recognised this was not sustainable in the long term, the report said.

The council has been contacted for comment.

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