Care Quality Commission's review highlights weaknesses in leadership of Wiltshire's health and social care
In a report published today (June 14) following a wide scale and detailed review of health and social care services in Wiltshire, the Care Quality Commission (CQC) have made some stern criticisms of the services' leadership in the county - especially in relation to Wiltshire Council.
A team of fifteen people from the CQC visited the county over seven days in February and March. The review was not an inspection so the CQC normal criteria and gradings were not used.
However, no overall criticisms were made on the grounds of patient safety, effectiveness of services, whether services are caring and responsive to people's needs - which are the normal CQC inspectors' criteria.
The review made a particular point of 'churn' at the top levels of Wiltshire Council - as regards adult social care - and of the Wiltshire Clinical Commissioning Group (CCG) - as regards NHS care.
The timing of the CQC' review was not ideal: "People we spoke with had been optimistic about the interim leaders of the CCG and local authority, and felt that relationships were improving however two weeks after our review the interim [Director of Adult Social Care] left the local authority and the Director of Public Health was appointed as the new interim DASS."
"This came at a difficult time for the local authority as, at the time of our review, the Director of Public Health was managing a major incident at Salisbury NHS Foundation Trust and Wiltshire had been affected by severe weather conditions."
The CQC's main criticisms are of the way the various parts of the county-wide system work together. The review mentions the proposed post for a joint Wiltshire Council Corporate Director/NHS Accountable Officer - as a step towards integration of social care and health care.
Plans for this joint post were scrapped three days before the review was to be published. The CQC report says: "...the leadership of services...by interim roles meant that stability and authority of service leadership could be undermined."
"The scope of the joint post and what it was expected to deliver was not clearly defined at the time of our review [February-March]. The management structure that would be required to support the joint post had also not been defined."
The CQC are not at all happy with the county's 'well-established' Heath and Wellbeing Board (HWB): "...the HWB was operating very much as a formal council committee with public meetings taking place on a bi-monthly basis."
From its inception in 2012, Baroness Scott has chaired the HWB. She has recently made the Chair of the CCG, Dr Richard Sandford-Hill, the HWB's Joint Chair.
Picking up their criticisms of the HWB, the first item on the CQC's list of 'areas for improvement' states: "System leaders in health and social care must work more effectively together to plan and deliver an integrated strategy across Wiltshire which includes an updated Better Care Plan."
And there are criticisms of the existing Better Care Fund (BCF) which funnels NHS money to Council based and run schemes. The review said leaders were not using the BCF "...effectively to jointly shape services to reduce admissions to and improve discharges from, hospital." It has some detail analysis of the problems with delayed transfers of care.
Addressing issues within Wiltshire Council, the review calls for improvements: "There appeared to be some lack of clarity and overlap of roles between elected members and senior officers in the local authority." They call for 'clearer differentiation' between councillors and senior officers.
Commenting on the review, Councillor Jerry Wickham (Cabinet member for adult social care, public health & public protection) said the Council was 'extremely pleased that the services were found to be safe': "The CQC's findings are very much in line with our own assessment of the local system and how it works, and, most importantly, where further improvement can be made."
For the CCG, Dr Sandford-Hill said: "This is a comprehensive and realistic report...we also acknowledge we still have much to do to improve our joint services on behalf of Wiltshire people."
The full CQC report can be read here.