Representing estates and facilities professionals operating within the  



The ‘integration lottery’

The report, ‘State of Health Care and Adult Social Care in England’, published by the Care Quality Commission (CQC) finds that whilst most people in England receive a good quality of care, this is by no means consistent or universal. 


The report uses CQC data as at July 31, 2018 to look at trends, share examples of good and outstanding care and highlight where care needs to improve.


The challenge for all local health and social care services is to recognise the needs of their local populations and find sustainable solutions that put people first. In this context, the CQC report considers five factors that affect the sustainability of good care for people – access, quality, workforce, demand & capacity and funding & commissioning. 


Access to care varies geographically across the country. Some people cannot access the services they need, or their only reasonable access is to providers with poor services. Ian Trenholm, Chief Executive of the CQC, comments on this aspect of accessibility in a blog. He says: “Access to good care increasingly depends on where in the country you live, what care needs you have and how well your local health and care system works together – an ‘integration lottery’.


“Local systems are made up of a variety of services which in turn make up a person’s experience – not as individual episodes of care, but as part of their health and social care journey.


“We know that ineffective collaboration between local health and care services can result in people not being able to access the appropriate care and support in the community that would avoid unnecessary admissions to hospital. This leads to increased demand for acute services, with the most visible impact of this being pressure on emergency departments.”


The overall quality of care in the major health and care sectors has improved slightly, but at the same time, the report says too many people are receiving care that is not good enough and this cannot be ignored. In particular, safety is a concern. While there are small safety improvements in NHS acute hospitals, too many need to do better. NHS mental health services also need to improve substantially. To back up this conclusion, 40% of NHS acute hospitals’ core services and 37% of NHS mental health Trusts’ core services were rated as requires improvement on safety at the end of July 2018.


Workforce problems have a direct impact on care, although the report emphasises that problems in recruiting, retaining and developing staff should not be blamed for failure to provide good quality care. 


The report states: “With proactive planning and management, acute hospitals can work to mitigate staffing issues. It is important that national workforce shortages do not become an excuse for poor care. On our inspections, we have found some Trusts that are struggling with staffing blaming national shortages and failing to recognise their own role and responsibility to ensure a safe level of staffing for patients. This can include a lack of focus on succession planning and internal governance of workforce issues.”


Getting the workforce right is crucial in ensuring services can improve and provide high-quality, person-centred care.


Demand is rising, not only from an ageing population but from the increasing number of people living with complex, chronic or multiple conditions, such as diabetes, cancer, heart disease and dementia.


Providers face the challenge of finding the right capacity to meet people’s needs. Services need to plan - together - to meet the predicted needs of their local populations, as well as planning for extremes of demand, such as sickness during winter and the impact this has on the system.


Care providers need to be able to plan provision of services for populations with the right resources, so good funding and commissioning structures and decision-making should be in place to help boost the ability of health and social care services to improve.



The foreword to the report by Ian Trenholm and Chair, Peter Wyman, says: “In our review of local health and care systems, we found that in too many cases, ineffective coordination of services was leading to fragmented care. Funding, commissioning, regulation and performance management all conspired to encourage a focus on individual organisational performance, rather than ensuring people got joined-up care based on their individual needs. Without incentives that drive leaders together, rather than push them apart, individual providers will increasingly struggle to cope with demand - with quality suffering as a result.”  


“Good, personalised, sustainable care in a local area is no longer just about whether individual organisations can deliver good care, but whether they can successfully collaborate with other services as part of an effective local system. The urgent challenge for Parliament, commissioners and providers is to change the way services are funded, the way they work together, and how and where people are cared for.”


The CQC’s view that services need to come together as a system was echoed throughout the recent Healthcare Estates conference programme. Delivering one of the programme’s keynote presentations, Nick Hulme Chief Executive of East Suffolk and North Essex NHS Foundation Trust and STP Lead for Suffolk and North East Essex STP, said it is time for the NHS to start working in systems, not individual organisations. Furthermore, those systems need to be the entire system, involving other local services within the neighbourhood. [For more on this see the November/December issue of HEFMA Pulse magazine].


Click here to download the report.