This report is one of 20 targeted local system reviews looking specifically at how older 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 people aged 65 and over living in a local area.
During the review carried out in April 2018, CQC 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 review found there was a system-wide commitment to serving the people of Northamptonshire but that services had not always worked effectively together. It highlighted a number of areas where improvements are needed to ensure those responsible for providing health and social care services work better together.
Professor Steve Field, CQC’s Chief Inspector of General Practice, said:
“Our review of health and social care services in Northamptonshire found that while there is an intent from the system’s new leadership to improve how people move through health and social care services, the reality for people has been variable with fragmented services leading to disjointed care and unsatisfactory experiences for older people.
“There were some significant barriers to progressing the transformation agenda in Northamptonshire including poor relationships, financial constraints and issues of capacity in both the acute trusts and within the adult social care market.
“We found that there were limited services to help maintain older people’s health and well-being in the community and services to help them avoid hospital admission.
If an older person was admitted to hospital, they were more likely to have longer hospital stays and people’s experience of being discharged from hospital was not always timely or person-centred.
“The government had appointed commissioners to oversee financial management activity in Northamptonshire County Council and made a recommendation for the local authority to be replaced with two unitary authorities.
“System leaders acknowledged that effective partnership working and a strong vision was integral to improving health and wellbeing outcomes for the people of Northamptonshire. We found that there was a renewed commitment from system partners to deliver improved and integrated health and social care services, and this was supported by a clear strategy emerging from the recently reset Sustainability and Transformation Partnership (STP) plan.
“We found that the STP plans had a strong focus on collaborative working. There were key work streams in place such as operations, finance and the development of a frailty model but they were all in early planning stages.
“There is a need for partners to take this important work forward at pace so that older people are seen and cared for at the right place at the right time by the right people.
“We have presented our findings to the new health and social care system leaders in Northamptonshire so that they can prioritise and continue to improve and work together in bringing joined up care to people living in the county.”
Overall CQC reviewers found:
- People in Northamptonshire had a varied and sometimes unsatisfactory experience of health and social care services.
- Hospital occupancy rates were high and both acute hospitals were failing to meet the national A&E target for time taken to be seen, assessed and treated. Some recent service design changes at Northampton General Hospital NHS Trust had led to improvements in performance, but it was too early to determine if these could be sustained.
- There was no systematic or joined up approach across the county to use feedback from people, their families and carers, and public involvement in the development of strategy and services.
- Older people continued to stay longer in hospital and bed capacity issues meant some people were not cared for in the most appropriate place by the most appropriate staff.
- While there was a strategy for integrated, community, place-based care, arising from the Sustainability and Transformation Partnership (STP), this had not been developed into a single, coherent vision for Northamptonshire which could be clearly articulated by all staff.
- Aside from the Better Care Fund (BCF), there were limited examples of pooled budgets in place for the delivery of services across health and social care for older people.
- There were significant workforce pressures in a number of health and social care disciplines across services. This was having an impact on areas such as the number of unallocated social care cases and referrals.
This review makes a number of suggestions of areas where the local system should focus on to secure improvement including:
- Relationships between system leaders across organisations must improve, in particular between providers and commissioners, which was hampering progress towards integration.
- Integrated working between secondary and primary healthcare and social care services needs to be strengthened.
- The system needs to work together to develop and drive forward a shared strategic vision for the future.
- Improving information sharing across health and social care should be prioritised, as this has proved a barrier to integrated working.
- There needs to be a greater commissioning focus on developing preventative services.
- More evaluation and sharing of lessons learned across the whole health and social care system was needed. We did not see system-wide ownership of performance
CQC reviewed eleven care and treatment records and visited ten services in the local area including acute hospitals, intermediate care facilities, extra care facilities, care homes and GP practices.
The Northamptonshire local system review looked principally at how people move between services provided by 253 residential care and nursing homes, 153 homecare agencies, 79 GP practices, Northampton General Hospital NHS Trust, Kettering General Hospital NHS Foundation Trust and Northamptonshire Healthcare NHS Foundation Trust.
This review was carried out following a request from the Secretaries of State for Health and 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.