CQC Local System Review of Cumbria Highlights Inconsistent Implementation of Joint Working Strategy

The Care Quality Commission has published its findings following a local system review of Cumbria. 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 home care agencies work together to provide seamless care for older people living in a local area. The review considered how the system was performing for people aged 65 and more, focusing particularly on typical pressure points.

CQC reviewers found that older people in Cumbria had inconsistent experiences of health and social care. While the organisations involved do have a health and wellbeing strategy and a vision for the whole of Cumbria, there was inconsistency in how the strategy was interpreted and how services were delivered.

• There are Cumbria two sustainability and transformation partnerships (STPs) and two clinical commissioning groups, for the north and south of the county. The STP plans differed in their interpretation of the health and wellbeing strategy and there were no specific links between the two plans.
• The vision for the health and social care system was that services across the whole of Cumbria would be delivered through 15 integrated care communities which would tailor services to the needs of people living in each local area. This approach was viewed positively across the system but the integrated care communities were newly established and at different stages of maturity in different areas.
• People waiting to be discharged from hospital in Cumbria did not always have a positive experience. Some people experienced long delays because of hold-ups in the assessment process, because home care packages were not available, and owing to a shortage of suitable care home placements.
• There had been some recent improvements with senior health and social care leaders working together in reducing delays, but it was too early to tell whether these improvements would be sustained in the longer term. 
• In primary care, CQC saw there was excellent leadership, especially in the south that was helping drive change and improvement at Integrated Care Community level.
• The system had not resolved the key challenge of ensuring that a suitably skilled health and social care workforce was available in sufficient numbers to meet the needs of local people.
• The system needs to work better with independent care providers and with voluntary and community sector services, which play a vital role in keeping people well and out of hospital.
• Other barriers to integration persisted, such as separate ICT systems that led to difficulties in information sharing and duplication of effort.

Professor Steve Field, Chief Inspector of Primary Care Services, said “It is clear that across Cumbria system leaders are keen to build relationships, and improve how they worked together. However, this work is at an early stage and is fragile.

“We could see that the implementation of the health and wellbeing strategy was leading to pockets of progress, with initiatives preventing people from being admitted to hospital unnecessarily and being supported to stay well in their own home.

“However, we found there was variation between how each integrated care community operated, and significant work was needed to ensure that people across the county consistently experienced high-quality care services that met their needs. This would involve more robust planning, governance and performance measures.

“The health and wellbeing strategy, although focusing on improvements to long-standing issues such as keeping people out of hospital avoidance and maintaining people at home, was reactive rather than proactive. This was a missed opportunity to think more creatively about meeting the needs of a diverse and often rural community.

“While it is encouraging to see plans being developed and it is clear that health and social care professionals have real desire to join-up services, the system is very early in its journey towards integration.”