The Care Quality Commission has undertaken a local system review of the health and care system in Bradford District. The Strategic Director, Health and Wellbeing will submit Document “C” which presents the findings of that review and describes the next steps in the review process.

Recommended –

(1)  That the positive assurance provided by the Care Quality Commission local system review be noted.

(2)  That the Committee supports the on-going implementation of the action plan, through the usual scrutiny processes.

(James Drury – 07970 479491)

The Care Quality Commission had undertaken a local system review of the health and care system in Bradford District. The Strategic Director, Health and Wellbeing submitted Document “C” which presented the findings of that review and described the next steps in the review process.

A presentation giving the context, approach and next steps of the review was provided to Members.  It included the following information:

The Approach:

•         Focused on the interfaces  between social care, general  primary care, acute health  services, community health  services and on older people aged over 65

•         Considered system performance along a number of ‘pressure  points’ on a typical pathway of care

•         Each area had a local report and the findings of the reviews would also be  used to inform a national report to give overall advice to the Secretaries of State

•         Reports did not include ratings and the reviews did not affect existing ratings

Progress and Next Steps:

•      The CQC completed the on-site elements of their review in February 2018

•      System-wide Summit took place in May 2018

•      The CQC published their local system review of the Bradford District system in May 2018, and had recently published their national report which in part was based on learning in Bradford

•      An action plan was finalised in July 2018 and shared with the Department of Health and Social Care

•      The Health and Wellbeing Board owned the report on behalf of the system, and the Integration and Change Board would oversee implementation of the action plan on behalf of the Health and Wellbeing Board

•      The Department of Health and Social Care would check on progress periodically

Report Findings:

•      There was a clear shared and agreed purpose, vision and strategy. This was articulated throughout and at all levels of the system.

•      System leaders across health and social care were compassionate and caring. System leaders encouraged the development of communities to build support around the person.

•      There was a defined system-wide governance arrangement that pulled the system together.

•      At an operational level, there was more work to be done to embed integrated working.

•      The system needed to continue to build on relationships to engage all as equal partners.

Recommendations:

•      System leaders needed to address issues around quality in the independent social care market

•      To build on good relationships that existed between stakeholders and extend this to include the independent care sector more fully

•      The commissioning of 15 minute domiciliary care visits needed to be reconsidered.

•      There needed to be clearer signposting systems to help people find the support they needed, particularly for people who funded their own care.

•      System leaders needed to ensure that staff in health services and independent social care provider services had a better understanding of peoples rights, the Mental Capacity Act etc.

•      The commissioning approach to primary care needed to maximise the outcomes from the two at-scale GP models emerging in Bradford.

•      To streamline processes when people are discharged from hospital with less reliance on paper based systems.

•      Medicines management when people had left hospital needed to be improved.

Following the presentation, the Chair stated that, during a meeting with CQC representatives during the review, they had spoken positively about Members having a good understanding of how the system worked and their scrutiny role. 

A Member commented that the report was well written, easy to understand and informed Members of what they needed to know at this stage. 

A Member queried what actions would be taken to address the difficulties in obtaining GP appointments and the linked rise to A&E attendance.  In response, it was reported that the Clinical Commissioning Groups had a plan to offer extended hours at GP surgeries and were considering how GPs could work together better across the primary care setting.  The use of social prescribing and the Community Connector service, funded by the CCGs and delivered by a consortium of local charities, was also available and could be signposted to within GP surgeries and hospitals.  It was also reported that Airedale Hospital was meeting the Government’s A&E waiting time target (95% of people to be seen and dealt with within four hours).

A Member considered that, from the information presented, the leadership across health and social care was good but it was important to ensure systems were sustainable if the leadership was to change.

In response to a Member’s question, it was reported that although there were 88 active residential care homes as stated in Appendix 1 of Document “C”, ten had not yet been inspected by the CQC  and therefore only 78 were included in their ratings breakdown.  The Scrutiny Lead officer added that the Committee were due to receive a report from the CQC on 28 October 2018 on their inspections across the district.  She also stated that the Committee were due to receive the Health and Wellbeing Board Annual Report on 4 October 2018 and she would request for the Action Plan relating to this review to be appended to that report.

A Member raised a concern that the Mental Capacity Act had been in force for 13 years and staff were still having difficulties understanding it and explaining it to patients.  She suggested the Council could have a Champion.  In response, it was reported that there was training and support provided to staff in residential care homes but there was evidently more work that was needed in this area and this was included in the Action Plan.  It was also reported that training on the Deprivation of Liberty Safeguards was being delivered to staff in care homes.

Resolved –

That the positive assurance provided by the Care Quality Commission local system review be welcomed.

ACTION: Strategic Director, Health and Wellbeing