Local System Review

In 2017, as part of a series of system reviews, the Care Quality Commission published the findings of their review of health and social care services in Stoke on Trent.

The review looked specifically at how older people move through the health and social care system, with a focus on how services work together. The CQC found that “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 because the health and social care system, led by Stoke-on-Trent City Council and Stoke-on-Trent Clinical Commissioning Group, is not working in a joined up way that is meeting their needs.”

The findings were damning and exposed a number of failings within the system that were sadly familiar to many local organisations. The difficulties in negotiating the local system that the report highlighted were similar to the frustrations experienced by many within the voluntary sector.

Since the report was published system leaders came together and agreed to collaborate in developing a joint system wide improvement plan. In late November 2017 our Strategic Liaison Officer took part in two small workshops to develop that plan.  The Voluntary Sector Chief Officer Group’s (VSCOG) open letter was shared with the group and was extremely well received leading to a desire to make the voluntary sector an integral part of the response and ongoing solution.

The Improvement Plan is broken down into key Strategic Improvement Themes including Leadership and Governance and Strategy and Commissioning. These are underpinned by specific workstreams such as Primary Care, Prevention and Mental Health. During the discussions it was agreed that the Voluntary Sector, in order to be fully integrated into the system-wide solution, needed to be considered as part of the overarching Improvement Themes rather than as one specific workstream and there is a clear commitment to embed the sector within the relevant sections.

Key points for the Voluntary Sector include addressing the overarching issue around the lack of involvement that the sector has at a strategic level.  The sector is not given the opportunity to consistently and constructively inform partners of the intelligence it has from “on the ground” or be part of the co-designing of potential solutions.  Therefore, within Leadership and Governance, there is a commitment to create a clear mechanism or platform for open dialogue and meaningful strategic engagement. Work on this is underway and will be updated as this progresses.

The CQC identified deficiencies and inconsistencies within the system, with no clear line of sight between commissioning approaches and wider Staffordshire priorities. The aim is to create a system where health and social care strategy, policy and commissioning intentions are consistent and targeting the same priorities. Therefore, a key action is to develop joint Health and Adult Social Care Commissioning Strategy for Stoke-on-Trent which will be supported by pooled budgets / programme budgeting. Importantly this strategy will include a joint approach to build capacity and embed the Voluntary Sector within the health and social care system.

It’s important to note that while this review was focussed on older people the Operational Group, who are taking this plan forward, recognise that much of the findings are symptomatic of the whole system and therefore this should drive improvement in joined up working partnerships on a broader scale.  Similarly, while this review focusses on the city, the approaches should be adopted across Northern Staffordshire where appropriate.

The Improvement Plan is continually evolving and version 19 was recently shared as part of a workshop where representatives across the local health and social care system had an opportunity to review the proposed plan, highlight any gaps and identify approaches that strengthen the actions identified within the plan. Thank you to those who took part in this workshop. Feedback from the event is being reviewed and the subsequent Improvement Plan will be shared shortly.

If you have feedback on the Improvement Plan’s identified actions or the role of the Voluntary Sector within this please contact our Strategic Liaison Officer: charlotte.bennett@vast.org.uk.