CQC backs integration approach to address care standards fears
New report praises adult social care providers for coping with demand pressures, but plays up need for better service integration through technology
The Care Quality Commission has issued a warning over the long-term sustainability of safe, higher quality care amidst financial and demand pressures that are driving a need for improved shared working and services, as well as new technology approaches.
According to the commission’s latest 'State of Care' report, while the majority of England’s health and adult social providers were delivering “safe, high quality and compassionate care”, strong leadership and improved interoperability between different organisations were seen as vital to maintaining standards.
CQC chairman David Behan said that although high quality care was largely being delivered despite challenging circumstances in delivering care, there was already variation in regards to standards between different providers.
Behan warned of a potential tipping point in the future for adult social care, with an aging UK population and increased numbers of long-term conditions leading to an increased need for, but reduced access to services.
“While there are no easy answers or quick fixes, what distinguishes many of the good and outstanding services is the way they work with others – hospitals working with GPs; GPs working with social care and all providers working with people who use services,” he said. “Unless the health and social care system finds a better way to work together, I have no doubt that next year there will be more people whose needs aren’t meet, less improvement and more deterioration.”
In its report, the CQC said it found that three quarters of adult social care services that had previously been rated as ’inadequate’ were found to have improved during the 2015/16 period. However, half of services previously rated as ‘requires improvement’- a total of 904 providers – had no change in their rating.
The report accepted that in line with longer-term strategies such as the NHS Five Year Forward View plan that aimed to set out blue prints for closer integration of health and social care, providers were adopting new technologies as part of efforts to find implement new means of delivering services.
“Some are engaging their own staff, other local care providers, local stakeholders such as Healthwatch, and the public to think differently about how they can deliver services together,” said the findings.
“[This includes] moving services closer to people’s homes, exploring the relationship with local care partners to improve hospital discharge rates, and supporting more people to manage their own care through the use of technology.”
Specifically in the case of primary care, the CQC said significant changes were also being seen in primary care with a push towards online GP services and practices working in federations or regional collaborations looking at cross-organisational working to better support patient needs.
“There is also a rise in digital services that offer remote consultations and advice using online technology,” said the report.
The CQC said it would be supporting ambitions for at least half the UK population to be accessing new forms of care in the next four years, for example through the previously announced vanguard programmes that will trial more local focuses around integrated care.
“We intend to learn alongside these new models as they develop. Registrations for new model services are still relatively low in number, but we expect this to change in the months ahead,” the commission said. “We will support innovation by removing barriers where we can.”
This was expected to include efforts to try and curb duplication of services and development.
According to the report, the securing of funding by local organisations remained a key challenge in maintaining current services while planning for future innovation.
To this end, the report noted that the Sustainability and Transformation Plans (STPs) required to be put together by 44 authorities on how they hope to meet the aims of Five Year Forward View would be a key part of balancing health and social care funding.
“This means making hard choices about the right balance of investment and about which services to provide and invest in,” said the findings.
In July, NHS England chief executive Simon Stevens said he expected STPs to be signed off this month to give more detailed direction on individual service strategies for integrated care.
Stevens said at the time that there was anticipated to be some variation between the 44 plans it received, noting that some areas will have worked together for a longer time and have a more articulated approach on locally implementing the Five Year Forward View.
“On the other end of the spectrum, there are some people, frankly, for whom this is the first time they have really been sharing their views together locally on how services need to change and they have a further path to tread,” he said.