The Care Quality Commission has published its findings following a local system review of Sheffield. 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 system-wide commitment to serving the people of Sheffield but that system partners had not always worked effectively together. It highlighted a number of areas where improvements are neededto ensure those responsible for providing health and social care services work better together.
Professor Steve Field, Chief Inspector of Primary Care Services, said:
“Our review of the local care services in Sheffield has found that there is a clear ambition to work together. Leaders within the city have been developing a Sheffield Accountable Care Partnership to provide a joined up approach to strategic planning and commissioning.
“While this offers a shared view of the design and delivery of services in future it would be fair to say that this had not yet been clearly articulated as a strategy that is understood by all parts of the system.
“We found that at operational level, staff understood that there was a desire to move towards a preventative approach – of helping people to live in their own homes where possible. But the staff were not clear on the plans for achieving this. This lack of clarity has had an impact on the pace of change that is needed to improve the interagency working between health and social care.
Overall CQC reviewers found that there was a strengthening of relationships and a strong commitment to achieve the best outcomes for people in Sheffield. Reviewers were told that Sheffield was at its best when facing a crisis and the system worked well together to address related challenges.
However in making positive tactical responses to system pressures this had sometimes diverted attention from the bigger picture and the transformation required. The previous Health and Wellbeing Board was ineffective in driving system delivery and transformation.
Although there had been improvements in information sharing and joint working most social care providers felt that they were not meaningfully involved or included in market shaping or service development.
Admission avoidance services were under developed and there was a lack of integration of health and social care. People at risk of deterioration were falling through the gaps and they reported not being listened to and experiencing a crisis before they received the support they needed.
People did not always experience safe discharges to their usual place of residence because of a lack of communication and coordination, adequate assessment and provision of services.
The review has made a number of suggestions of areas where the local system should focus on secure improvement including:
- System leaders must continue to engage with people who use services, families and carers and undertake a review of people’s experiences to target improvements..
- Health and social care leaders across Sheffield should work together to align their transformation delivery programmes and strategies. Health and social care must be equal partners in the system transformation programme.
A restructure of the Health and Wellbeing Board (HWB) would help align strategies and drive the vision for integrated services and the transformation programme.
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Notes to editor
The Sheffield local system review looked principally at how people move between services provided by 72 residential care homes, 47 nursing homes, 93 homecare agencies, 88 GP practices, and one NHS Foundation Trust. Community services are provided by, Sheffield Health & Social Care NHS Foundation Trust.
This review was carried out following a request from the Secretaries of State for Health and Social care and for Housing, Communities and Local Government to undertake a programme of 20 targeted reviews of local authority areas. The purpose of the reviews is to understand how people move through the health and social care system with a focus on the interfaces between services, and identify any areas for improvement.
During our visit to the local area we sought feedback from a range of people involved in shaping and leading the system, those responsible for directly delivering care as well as people who use services, their families and carers. The people we spoke with included:
- System leaders from Sheffield City Council (the local authority), Sheffield Clinical Commissioning Group ( the CCG), Sheffield Teaching Hospitals NHS Foundation Trust (STHFT), , Sheffield Health and Social Care NHS Foundation Trust, Primary Care Sheffield, Yorkshire Ambulance Service NHS Trust, Sheffield Health and Wellbeing Board and Healthwatch Sheffield.
- Health and social care professionals including care home and domiciliary agency staff, social workers, GPs, urgent care staff, enablement teams and health and social care provider representatives.
- Voluntary, community and social enterprise (VCSE) sector representatives.
- People using services, their families and carers during our visits to day centres and support groups and in focus groups.
We reviewed 18 care and treatment records and visited services in the local area including STHFT sites, intermediate care facilities, care homes, a domiciliary care agency, GP practices, out-of-hours services and the urgent care centre.
About the Care Quality Commission
The Care Quality Commission (CQC) is the independent regulator of health and social care in England.
We make sure health and social care services provide people with safe, effective, compassionate, high-quality care and we encourage care services to improve.
We monitor, inspect and regulate services to make sure they meet fundamental standards of quality and safety and we publish what we find to help people choose care.