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

11 May 2018
  • Media

The Care Quality Commission has published its findings following a local system review of Liverpool. This report is one 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 report found that there was a clear strategic direction for health and social care in Liverpool, focused on the needs of people living in the city, and described in the One Liverpool strategy.

However, the experiences of people using health and social care services varied. People were not always seen in the right place, at the right time by the right person; there were inconsistencies in commissioning and provision of services.

Local people were not actively enabled to participate in service planning and delivery, and a comprehensive public engagement strategy was needed to facilitate meaningful public involvement in shaping the future direction of the city. In addition, people using services and their carers were not always supported to take control in making decisions about their care, although they were keen to do so.

Liverpool had faced significant financial and system leadership challenges in recent years and this had been a barrier to effective integrated working. While CQC found that relationships were improving, between the health and social care sectors, these should continue to be strengthened, and joint approaches embedded to ensure that outcomes for older people are improved.

A neighbourhood model had been developed to bring together primary, community, mental health and social care services, but this model was not being implemented with a clear and consistent approach. For example GPs were not always participating in multidisciplinary meetings, which meant that older people in Liverpool were not always benefitting from integrated working in the same way.

The Liverpool health and social care system was making good progress in relation to technology and shared records, with universal use of the NHS number and considerable investment in shared records systems. Efforts had also been made to digitise domiciliary care, which although a positive step, had a negative impact for community health and social care teams who did not have compatible mobile technology.

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

“Although many older people experience the highest standards of care and support as they move between services in Liverpool, too often this does not happen. For the system to make progress its shared vision for One Liverpool needs to be taken forward in a jointly-owned operational plan involving all system stakeholders – including independent providers, voluntary sector organisations and people who use services and their carers.

“There also needs to be a consistent approach to the neighbourhood model, as our review team found inequity in services available and importantly in the engagement of GP providers with this approach.

“System leaders should work with providers to shape the care market, recognising independent providers and the Voluntary Community and Social Enterprise Sector organisations as partners. The quality of residential and nursing care in the city is poor and must improve. We will continue to work with the local authority, NHS commissioners and the providers themselves to ensure that people get the standard of services they are entitled to expect.”


For further information, please contact David Fryer, Regional Communications Manager - North, on 07754 438750.

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Last updated:
11 July 2018

Notes to editors

The Liverpool local system review looked principally at how people move between services provided by 49 care homes, 72 homecare agencies, 88 GP practices, one NHS Foundation Trust and two NHS acute Trust. Community services are provided by Mersey Care NHS Foundation Trust.

This review was carried out following a request from the Secretaries of State for Health and Social care and for Housing, 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.

During our visit to Liverpool we sought feedback from a range of people and organisations, including:

  • System leaders from Liverpool City Council, NHS Liverpool Clinical Commissioning Group, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Aintree University Hospitals NHS Foundation Trust, St Helens and Knowsley Teaching Hospitals NHS Trust, Liverpool Community Health NHS Trust, Mersey Care NHS Foundation Trust, Urgent Care 24, North West Ambulance Service NHS Trust, the Health and Wellbeing Board and the Council’s Social Care and Health Select Committee.
  • Health and social care professionals including social workers, GPs, discharge teams, therapists, nurses and commissioners
  • Healthwatch Liverpool, voluntary, community and social enterprise sector services, independent care providers (nursing homes, residential homes and domiciliary care agencies), the out of hours GP provider and GPs
  • People using services, their families and carers at the Liverpool Carers Centre, the Service User Reference Group and Making it Happen group. We also spoke with people in A&E and hospital wards as well as mangers and providers of residential and intermediate care facilitates.
  • We also reviewed 21 care and treatment records and visited 14 services in the local area including acute hospitals, intermediate care facilities, care homes, nursing homes, domiciliary care providers, GP practices, walk in centres and voluntary sector run activities.

This review report makes a number of suggestions of areas for the local system to focus on to secure improvement including:

  • Organisational development work needs to be undertaken strengthen relationships, improve communication and ensure there is a shared understanding among staff of the services available including each other’s roles and responsibilities in achieving the strategic vision.
  • System-level governance arrangements need to be strengthened to address performance and quality issues and facilitate risk-sharing as well encouraging learning and evaluation between partners. Outcomes from safeguarding investigations should be shared with referrers to provide assurance concerns have been managed in accordance with agreed policies and procedures.
  • The local authority needs to ensure it continues to fulfil its statutory obligation under the Care Act 2014 to provide assurance there is appropriate capacity of good quality services within the social care market to ensure people receive person-centred, safe, high-quality care.
  • System leaders need to address the inconsistencies in commissioning and service provision. For example, only 50% of GPs were participating in MDT meetings and other initiatives were not available in all neighbourhoods.
  • The personalisation agenda should be developed with more people supported to access personal budgets and direct payments.
  • Information flows between services, including independent care providers, need to improve to facilitate safe and timely discharges from acute hospitals. Specifically, the early involvement of community services and care providers, quality of discharge information and the sharing of discharge information.

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.