In the Care Quality Commission’s annual report to Parliament on the state of health and adult social care services, we warned the adult social care sector was “approaching a tipping point” and its fragility could put the quality of care that people should expect to receive at risk.
This followed calls from bodies representing adult social care providers, commissioners, people who use services and elsewhere that the sector was not appropriately set up to meet current and anticipated demand.
In the Spring Budget 2017, the government announced an additional £2bn for councils in England over the next three years for adult social care. This money was made available for three purposes: to increase the numbers of care packages available; to stabilise the social care market; and to help the NHS.
Alongside this investment, we have been commissioned by the health and communities secretaries to review how 20 local systems manage the movement of people through their health and care systems across primary, acute and adult social care, including how local authorities and clinical commissioning groups commission care and how services interact with each other. This work will highlight what is working well and where improvements are needed, both locally and nationally.
This is a new responsibility for the CQC but one the organisation is well placed to deliver given its ability to look across the whole system and focus on person-centred, high-quality care.
The Department of Health has identified 12 areas for review in Halton, Bracknell Forest, Stoke-On-Trent, Hartlepool, Manchester, Trafford, York, East Sussex, Oxfordshire, Plymouth, Birmingham and Coventry. We expect the remaining eight to be confirmed later on in the autumn.
Since we were commissioned to carry out this important piece of work, we have developed and co-produced our approach with people who use services and their families and carers; the Local Government Association; NHS Improvement; NHS England; NHS Clinical Commissioners; the Social Care Institute for Excellence; Think Local Act Personal and others.
We want to find out what the outcomes are for people as they move through the system. What is the capacity and capability of the local authority moving forward? How well are resources being used locally? What else may need to happen to support the best interests of people, their families and carers, who rely and depend on vital services?
Last month, I had first-hand experience of joining the review team in Halton to mark the start of the programme. I spent some time meeting the chief executive of the council and supported the team in interviewing key people from the local health and care system.
As I left, the team was drawing together the evidence that had been collected and forming their initial conclusions. We will produce a local report for here and every other local system under review, which we will deliver to the health and wellbeing boards of the council areas and all relevant partners. Each review will be very different because of the different challenges in each place. The way senior leaders and practitioners work together is crucial.
Once we have completed the full programme of work, we will also report nationally on all 20 reviews, with advice to the secretaries of state.
The need for this work could not be greater. People are living for longer, individual needs are becoming more complex, which therefore places a greater demand on services, and there is often a far from seamless journey for people as they move through the social care system. If the right type or quantity of care is not available, the pressure shifts to other parts of the system. This was well documented in the NHS last winter, when hospitals faced increased demand for A&E services and delays in discharging people to community and social care services.
The reviews will allow us to focus on winter pressures and consider if the additional money is starting to make a difference, in a way that is not possible when we look at individual organisations.
The questions raised in my mind so far are: is there a clear plan for how health and care services will meet the needs of older people safely and effectively, starting this winter? Are there good relationships at a senior and practitioner level to deliver the plan? Does the delivery of the plan ensure older people receive the right care in the right place at the right time? This is what the reviews will explore. Whether you are being reviewed or not, these are good questions for everyone to answer.
David Behan, chief executive, Care Quality Commission