A review has found older people living in Stoke-on-Trent sometimes have poor experiences of care and do not always have access to the right care, in the right place, at the right time.
The Care Quality Commission has published its findings following a review of health and social care in the city.
It says Stoke-on-Trent City Council and health bodies have failed to work together to meet residents needs.
Reviewers found that organisations and individuals designing and delivering services in the city were not working to an agreed, shared vision and that there was a lack of strategic planning, and commissioning with little collaboration.
CQC inspectors raised concerns about a shortage of GPs and variances in surgery opening times, and 'nervousness in the system' in respect of homecare capacity to meet extra demand during the winter.
The CQC said that meant that:
- People found it difficult to access a GP appointment in a timely way and as a consequence many people went straight to A&E or were referred to A&E by their GP.
- Older people often had poor quality experiences when they were admitted to hospital, including long waits in A&E before being admitted to a ward that met their needs.
- Older people were often delayed in hospital after they were ready to return home or move to a new care setting. In some cases people suffered avoidable harm or their condition deteriorated as a result of delays.
- People’s needs and care packages in the community were not reviewed as regularly as they should be. This meant that people may have been at risk of entering into crisis if their needs had changed. It also represented a missed opportunity when people’s conditions might have improved, to release capacity in home care services that could be used to support other people who need care.
The review described staff as having 'enthusiasm to do the right thing for people', but they expressed frustration at the lack of engagement and confusion regarding expectations and service planning.
Staff also told inspectors that changes were badly implemented, and there was little support during periods of transition.
Some were also concerned that learning from problems coping with demand last winter had not been used to inform planning for the coming winter, while voluntary sector providers said they had not been involved in arrangements, despite their ability to support people with initiatives aimed at maintaining their independence and wellbeing.
Professor Steve Field, Chief Inspector of Primary Medical Services and Integrated Care, said: "It is quite clear that some older people in Stoke-on-Trent have suffered a poor experience of care - because the local health and social care services have not been working together effectively.
"We have heard of a history of poor relationships across the system with limited joint working.
"The consequences are too many people ending up in hospital in the first place – or being unable to leave hospital because there are no support services available.
“Leading organisations in the health and social care system, including Stoke-on-Trent City Council and Stoke-on-Trent Clinical Commissioning Group, need to come work together urgently to improve services for people, and in particular develop how it works together to prevent people from requiring acute hospital care.
“Our team found that the workforce across the local authority and the CCG were willing and enthusiastic about doing the right thing for people; but did not have clarity about how to achieve this.
“However we have found that the working relationships between the main organisations have started to improve. It is encouraging that there are some new leaders working in Stoke-on-Trent who have a clear understanding of the challenges that the system faces and are committed to transforming services for people by working in more of a joined up way.”
This review makes a number of suggestions of areas for the local system to focus on to secure improvement including:
- There must be better and effective communication between leaders of the system.
- There must be effective joint strategic planning based on the needs of the local population with clear shared and owned outcomes.
- Attention should be given to long-term strategic planning across the system within an agreed joint performance framework.
- System leaders should ensure effective delivery of their integrated strategic plans.
- Strategic commissioning should be aligned to the agreed strategic plans and must include primary care.
- System leaders should ensure an integrated approach to market development which should include the monitoring of quality in the care and voluntary sectors.
- An effective system of integrated assessment and reviews of the needs of people using services should be introduced urgently.
- There should be integrated delivery plans which include resources and workforce.
- The trusted assessor scheme should be implemented as soon as possible.
You can read the full report here.