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Halton: CQC publishes its first review of how local health and social care systems work together

12 October 2017
  • Media

The Care Quality Commission has published its findings following a local system review of Halton in Cheshire.

This report is the first of 20 targeted reviews of local authority areas looking specifically at how 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 older people living in a local area.

The review found that there was a strong commitment and a shared vision across the local authority and the clinical commissioning group (CCG) to serve the people of Halton well.

There was a positive approach to maintaining people’s health and wellbeing in their own homes, with services designed for older people to keep them socially included, active and able to manage their long term conditions. There was good support for carers including those supporting people living with dementia.

Work was underway to provide older people admitted to hospital with better experiences by reducing avoidable hospital admissions and delayed transfers of care.

Following a joint analysis of need, new services had recently been introduced to avoid hospital admissions including a rapid seven-day re-ablement service and a rapid clinical assessment team. Transformation projects for care homes and domiciliary care were underway so that people’s individual needs could be met in a timely way.

As a result the numbers of delayed transfers of care were reducing and performance had improved.

The challenge for the system was to continue to implement its local plans at pace to embed the recent changes and to sustain the social care workforce.

The review found that the continuous improvement of patient flow through acute services and the provision of timely and sufficient community based services were crucial for the system to sustain improvements in performance and meet the challenges of increased demand as winter approaches.

Professor Steve Field, Chief Inspector of Primary Care Services, said:

“Our review of Halton's services - and how they work together - has demonstrated that a joint approach and a shared focus can improve people’s experiences of health and social care.

“We have found some great examples of good leadership, producing shared approaches and local agreements that support people living in Halton get access to the services and support that meet their individual needs.

“We were pleased to find that some new services and initiatives were having a positive impact and that delayed transfers of care were reducing. Performance has improved and is now better than the national averages.

“However, there is more that can be done. It is important that the flow of patients through the local hospitals continues to improve and that more community- based services are provided so that people continue to receive high quality services when they need them.

“Since Halton is served by two hospitals in neighbouring boroughs, there is potential for the system to fragment. It is vital therefore that Halton council plays a full part in the success of the Sustainability and Transformation Partnership and the emergent Accountable Care System to ensure future progress.

“Clearly the will to work together is evident: the local authority and the CCG have developed a very healthy relationship, and the local acute trusts are involved in planning for the future”


For media enquiries about the Care Quality Commission, please call the press office on 020 7448 9401 during office hours. Journalists wishing to speak to the press office outside of office hours can find out how to contact the team here. (Please note: the duty press officer is unable to advise members of the public on health or social care matters).

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Last updated:
11 July 2018

Notes to editors

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.

This review makes a number of recommendations including:

  • The Health and Wellbeing Board would benefit from increased vigour in calling system leaders to account to ensure that agreed plans and service improvements are delivered at pace.
  • A cohesive interface and robust alignment between the local authority’s and CCG's vision for the borough, the Local Delivery System, the STP and planned Accountable Care System should be developed. This alignment should be underpinned by shared success criteria, key performance metrics and formal joint governance arrangements so that the all partners have a voice and appropriate recognition in wider system planning.
  • While the local authority and the CCG work effectively together as commissioners in the borough, commissioning activity would benefit from increased care provider engagement including local NHS trusts and the GP federations.
  • The implementation of local strategies and plans to reduce avoidable admissions to hospital and improve delayed transfers of care should continue at pace.
  • Plans to meet winter pressures should be aligned and coordinated at a system level to ensure that actions between key partners, staff, and people are effective and communications with the public to deter hospital attendance are clear, helpful and consistent.
  • Further oversight and monitoring of commissioned services, particularly the intermediate care service provided at Warrington and Halton NHS FT, should be put in place by both the service provider and the service commissioner so that poor performance is actively managed and patient experience improved.
  • Data collection in different assessment processes across the system should be reviewed to avoid duplication.  This was particularly evident in assessment of people living with dementia and in the carer’s assessment process.
  • Now that strategic plans have been developed, strategic leaders should focus on delivery at the front line to improve outcomes for people in Halton.

The full report can be found at:

About the Care Quality Commission

The Care Quality Commission (CQC) is the independent regulator of health and social care in England.

We make sure health and social care services provide people with safe, effective, compassionate, high-quality care and we encourage care services to improve.

We monitor, inspect and regulate services to make sure they meet fundamental standards of quality and safety and we publish what we find to help people choose care.