Looking across an area helps CQC explore, on behalf of people using services, whether local health and care services are working together in ways that reflect people’s needs. The project that has resulted in these reports on Salford and Tameside was designed to find out if CQC would be able to form a view about quality across an area as a whole. CQC recognises that its existing regulation of individual care providers, such as hospitals, care homes or GP services needs to develop to reflect the changing ways in which care is being delivered.
David Behan, CQC’s chief executive said: “In these two reports we have attempted to answer the questions ‘If I live in Tameside or Salford what will be my experience of health and care services? If I have multiple needs are services joined up?’ CQC needs to look at the quality of care people receive across areas and between services. Having a better understanding of how different parts of the health and care system work together should also help drive improvement.
“By 2020, 50 per cent of the population should be receiving care in a range of new ways and from organisations that bring different elements of care together. Quality of Care in a Place is one of a number of ways we have been looking at how we can assess the quality of care beyond individual providers.
“Together these projects are helping us to build our capability to inspect, report on and rate new models of care, such as vanguards, and the range of different services that people use. Our work is also designed to support areas to innovate and collaborate and make informed decisions about local services.”
The Quality of Care in a Place project will shape CQC’s future role beyond provider-based regulation. It sits alongside other reviews looking at how CQC could assess the quality and coordination of urgent and emergency care within an area; the extent to which how care is integrated affects older people’s experiences of care; and the implications of emerging new models of care for how CQC should operate in the future. The project tested how CQC could assess quality and encourage improvement at a system level, increase transparency for local people, inform how CQC might respond to new models of care as they develop, and provide a rounded picture of local services for CQC’s local inspection teams. Information about an area from CQC can support local areas to plan and deliver care that’s more responsive to local people’s needs and more sustainable. This links both to new care models such as vanguards and to the new sustainability and transformation areas that are drawing up plans for better integration of health and care services.
Stephanie Butterworth, Executive Director at Tameside Metropolitan Borough Council, said: “We were happy to take part in the pilot and welcome any further work in support of the CQC which aids a better understanding of how they can assess quality of care and encourage improvement for our residents.”
The prototype reports will be evaluated to understand if CQC can demonstrate whether reporting on quality of care in a place can encourage improvement locally. Feedback from local organisations and local people will be an important part of the evaluation. CQC will also be exploring whether reports can help CQC’s inspection of health and care providers by giving its inspection teams more context about an area. All three Quality of Care in a Place reports have taken different approaches to the work, but none should be considered inspection reports and areas have not been rated. As the purpose was to test methodology, the findings should be considered indicative only.
The Salford report
To arrive at a view of the quality of care in Salford CQC brought together information from a range of different sources. These included ratings from CQC inspections and findings from inspection reports data from others about the outcomes of care locally; the views of people involved in health and social care in Salford by means of interviews and focus groups; CQC’s local inspectors; case studies to understand how well services work together, from the point of view of people who uses services and the professionals providing care.
Overall CQC found that Salford has a clear vision, strategy and plans which include significant changes to health and social care in order to better meet local needs. There is evidence of good and outstanding quality health and social care for people in Salford. This is both at the level of individual providers and in initiatives taken to innovate and integrate services. There is strong leadership and partnership, founded on commitment to making a positive change for local people.
There is strong evidence that the four statutory partners in Salford (Salford Royal Foundation Trust, Salford Clinical Commissioning Group, Salford City Council and Greater Manchester West Mental Health Trust) successfully work together and have a strategy for how to improve care in the area. Local leaders and partners are responsive to local need, identifying areas for improvement and taking effective action to make things better for local people. Out of seventy seven Adult Social Care Providers in Salford forty six have been rated, and of those rated to date, 19 (41%) have been rated as good, twenty four (52%) as requires improvement and three (7%) as inadequate.
Out of the thirty one GP practices in Salford that have been rated, two practices were rated as outstanding, twenty six as good and three as requiring improvement. Currently Salford has a higher proportion of GPs rated as good (48%) or outstanding (4%) than the national average. Salford Royal NHS Foundation Trust (SRFT), which provides both acute and community services, has been rated as outstanding by CQC. The Salford Royal Hospital was rated as outstanding overall and community health services were rated good overall. There are some challenges identified in the review which Salford may consider giving attention to. This includes delays in Care Act assessments and occupational therapy assessment in the community. Of concern are the problems with access and unmet need for the high level of more general mental health and well-being needs in the community. Some initiatives to address this are being piloted and mental health is being integrated within Salford’s reconfiguration of care.
However, the review findings suggest many of the gaps identified in the 2010 health and well-being needs assessment continue. An update of this needs assessment may help Salford decide where best to focus resources to address these issues.
The Tameside report is a “data only” report, produced to provide an example of what this type of report could tell us about Quality of Care in a Place. This complements the work in the two other pilot areas where additional methodologies were tested. CQC’s own data on providers was instrumental to this project. However, data from other sources was also used, particularly when looking at population outcomes.
Section two is informed by data from Public Health England (PHE), the Health and Social Care Information Centre (HSCIC) and NHS England, in addition to CQC publications. The report does not present any overall conclusions about the quality of care in Tameside, but it does enable local health and care commissioners and providers to see how different aspects of health and care are performing and in many cases how these compare nationally. Further work taking into consideration local knowledge would be necessary to inform any judgement about the quality of care. CQC published a report on North Lincolnshire in February