The Care Quality Commission has published its findings following a local system review of Stockport. This report is one of 20 targeted reviews of local authority areas looking specifically at how people move through the health and social care system, with a focus on how services work together.
The reviews look at how hospitals, community health services, GP practices, care homes and homecare agencies work together to provide seamless care for older people living in a local area.
This review found there was a well-defined strategic vision that was designed to meet the specific needs of Stockport residents. Through the ‘Stockport Together programme’, the five main health and social care organisations in Stockport came together to work in partnership
Reviewers found some good initiatives in place to respond to people’s needs and prevent admission to hospital; for example the Neighbourhood Care Model, a multi-disciplinary approach to case management incorporating GP support. However this was in the early stages of development.
There was a commitment from staff at all levels in the system to provide person-centred care, reduce isolation and to empower people to make decisions about their care and support needs.
But if an older person living in Stockport went into crisis and required an emergency hospital admission, they might suffer long waits in A&E and were more likely to remain in hospital longer than required. This was often due to a shortage of homecare packages or the availability of high-quality residential care.
People admitted to Wythenshawe Hospital often had a longer wait for social care assessment than those in Stepping Hill Hospital. Reviewers found that services planned at both hospitals sometimes added to system pressures. A&E wait times at Stepping Hill were too long.
The review recommends that care home and home care providers are better involved in the planning and completion of hospital discharges from an early stage. The system overall should embed the High Impact Change model to reduce the need for people to remain in hospital longer than necessary.
The review found that there were significant pressures in securing a sufficient workforce. Community social workers said they were carrying large and complex caseloads; this was often because of a lack of hospital social workers. Reviewers found the Health and Wellbeing Board and Adult Social Care and Health Scrutiny Committee lacked oversight of strategic decisions and areas of risk across the system, this was acknowledged by the board.
Professor Steve Field, Chief Inspector of Primary Care Services, said:
“Our review found that the system in Stockport had a clear ambition to work together and a connected ambition to work within the wider Greater Manchester conurbation.
“The partnership has the potential to significantly improve health and social care outcomes for people but all system leaders we heard from recognised that they were behind schedule with transforming services and needed to make changes more quickly.
“In the past year the developing neighbourhood care model had led to some more positive outcomes for people by enabling staff from different organisations to work together, helping people to be discharged from hospital more quickly and live well in the community. However there was still much to be done to ensure consistent, timely high quality care for local people.
“It is encouraging to report that local authority and NHS commissioners had a clear idea about their role and responsibilities to transform local services, although it was not always clear who was making the important decisions on the delivery of really integrated services and where accountability lays. This is a challenge for local leaders to address so that the required transformation of services can continue at pace.”
The review has made a number of recommendations for areas where the local system should focus on to secure improvement including:
• The system must ensure there is a Stockport-wide workforce approach, in alignment with the Greater Manchester workforce strategy. This must be a clear system-wide action plan to provide a competent sustainable workforce.
• Independent adult social care providers should be included in the development of the workforce strategy so that recruitment and retention across all health and social care sectors can be improved.
• Continuing healthcare (CHC) requires review, to ensure people’s rights are being met and people’s needs are identified and actioned in a timely manner.
• System leaders must work together with providers to shape the market, recognising independent providers as system partners, ensuring they are involved in strategic planning and market shaping, to determine how the needs of the people of Stockport can be effectively met.
• System leaders should work to ensure that people receive consistent quality and access to care, and address the inconsistencies in people’s experiences across both acute trusts.