Policy briefing

CQC recommends new approaches to older people's care

CQC recommends new approaches to health and social care for older people

Care Quality Commission's Beyond Barriers report explores how older people move between health and social care services in England

Fixing the missing piece between health and social care for older people is 
subject of a CQC report

Essential facts

Many older people have complex and long-term care needs that require more than one professional and more than one service. Their experience depends on how well services work together with and for them, their families and carers.

What’s new?

The Care Quality Commission (CQC) completed 20 local authority area reviews exploring how older people move between health and social care services in England.

Its report Beyond Barriers highlights examples of services working well together and of individuals working across organisations to provide high-quality care. But the reviews also found too much ineffective coordination of services, leading to fragmented care. This was reinforced by funding, commissioning, performance management and regulation that encouraged organisations to focus on individual performance, rather than on positive outcomes for older people.

The lack of a shared plan resulted in people not receiving the right care in the right place at the right time, with consequences ranging from care being provided at greater expense than necessary, increased pressure on services and adverse effects on people’s quality of life.

Urgent requirements

The CQC states that person-centred, coordinated health and social care is an urgent and immediate requirement. It sets out several recommendations including:

  • The development of an agreed joint plan created by local leaders for how older people are to be supported in their own homes, helped in an emergency and then enabled to return home.
  • Long-term funding reform to enable health and social care services to pool their resources and use their budgets flexibly.
  • Long-term investment in services and population-based budgets.
  • A single joint framework for measuring the performance of how organisations collectively deliver improved outcomes for older people. This would operate alongside oversight of individual provider organisations and reflect the contributions of all healthcare organisations.
  • The development of joint workforce plans, with more flexible and collaborative approaches to staff skills and career paths. Leaders should make it easier for individuals to move between health and care settings, enabling people to gain skills in a variety of different settings so that services can remain responsive to local population needs.
  • New legislation to allow the CQC to regulate systems and hold them to account for how people and organisations work together to support people to stay well and to improve the quality of care people experience across all the services they use.

Implications for nurses

The contribution of community nurses is key to improving older people’s experience. The report notes that when primary and community care services work together with social care and adopt a person-centred approach, people’s needs are met. However, between 2009 and 2017 there was a 40% reduction in the number of community matrons and a 44% drop in the number of district nurses. At the same time, the number of nurses caring for adults in hospital increased by 8%.

The result is that people are being admitted to hospital to receive interventions that could be delivered in the community, for example, catheter care. Healthcare assistants and domiciliary care staff are also undertaking clinical duties that might traditionally have been done by district nurses, such as providing wound care.

Increasing rates of emergency hospital admissions for older people could also be avoided if they received the right care in the community. Where they are in place, community matrons, nurse prescribers, intermediate care teams and care home support teams provide comprehensive support in care homes to avoid hospital admissions.

Expert comment

Chief executive of Care England Martin Green says:

‘This new approach is to be welcomed particularly the recommendation for better oversight of local systems and commissioning.

'New regulation we hope will allow CQC to regulate not just individual organisations, but the quality of service for people across systems.

‘Improving regulation is a huge part of the jigsaw, but will not be complete without commensurate funding to plug the shortfall in adult social care.’

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