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Manchester health and social care: Progress on integrating health services, but lots more work required
The Care Quality Commission has published its findings following a review of health and social care in the city of Manchester.
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.
CQC found that there was a sense of a true partnership between health and social care services in Manchester, based on a period of time building relationships across the system, including voluntary, community and social enterprise agencies.
Local leaders of both Manchester City Council and NHS Manchester Clinical Commissioning Group envisaged that the current challenges in health outcomes for Manchester would be addressed through the radical transformation in the integrated commissioning of care services.
However, the system in Manchester has significant problems that must be addressed in the immediate future. People’s experiences of receiving services differed across the city, there were high numbers of emergency admissions to hospital, and once people were in hospital, they were more likely to remain there for longer than they should
- In the north of the city there were good arrangements to support people in the community to prevent hospital admission. However, once people were admitted to hospital their discharge was more likely to be delayed.
- In the centre of the city there were fewer joined-up services to prevent hospital admission, although when people were ready go home or to a new place of residence, they were less likely to be delayed.
- People who attended A&E often had to wait for more than four hours, and there were high numbers of people who had to wait for more than an hour in ambulances. This could be distressing for people who were unwell and waiting to be seen.
- People living in care homes in Manchester were at a greater risk of becoming unwell from avoidable illnesses such as pneumonia and urinary tract infections than people in similar areas.
- Care for people at the end of their lives was inconsistent; although in the north of the city there was a multi-disciplinary team to support people in their own homes, this was not available to people in the centre or south of the city and there was no hospice in Manchester to support people at the end of their lives.
Professor Steve Field, Chief Inspector of Primary Care Services, said:
“I know that Manchester’s political and healthcare leaders have a strong understanding of the challenges posed by poor population health, and poor health and care outcomes."
“Our review of Manchester’s services and how they work together has found encouraging progress has been made in the establishment of joint commissioning, creating conditions for change."
“There is a lot to do. Overall we could see there were areas of good practice in parts of the system. Where services were already integrated, staff reported that relationships between professionals such as occupational therapists and physiotherapists were good, with improved communication and information sharing."
“We found there were workforce pressures in a number of areas, and social workers were carrying high and complex caseloads. This meant that there was a waiting list for assessments and a risk that people who were not having their needs assessed could end up as emergency cases."
“However – the key organisations have now created a clear strategy that is built on partnership working. We found that this was clearly understood at all levels of health and social care commissioning organisations, providers and voluntary sector organisations. Staff that we met throughout the review were enthusiastic and believe that it is a force for positive change.”
For further information please contact CQC Regional Engagement Officer Kerri James by email firstname.lastname@example.org or by phone on 07464 92 9966.
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- Last updated:
- 23 February 2018
Notes to editors
In February 2015 system leaders in Manchester were among 37 NHS organisations and local authorities that signed the Greater Manchester devolution agreement with government which would enable them to take control of health and social care spending and decision making in the region.
The Manchester local system review looked principally at how people move between services provided by 85 care homes, 65 homecare agencies, 97 GP practices In the main central conurbation acute care was provided by Central Manchester University Hospitals NHS Foundation Trust and University Hospital of South Manchester NHS Foundation Trust, who have recently merged to create Manchester University NHS Foundation Trust.
In the north of the city acute care is also provided by Pennine Acute Hospitals NHS Trust. Mental health services are provided by Greater Manchester Mental Health NHS Foundation Trust
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 suggestions of areas for the local system to focus on to secure improvement including:
- There needs to be a greater focus on current operational delivery improvement while developing the transformation agenda.
- There needs to be more robust commissioning and quality contract monitoring to improve the quality of social care services in the city.
- The homecare model is outdated, being time and task focussed and needs to move to a strength-based approach.
- Work is needed with other system leaders within the Greater Manchester area with regard to the secondary care sector to enable streamlined, uniform processes that reduce the need for frontline staff having to work with a number of different systems.
- There needs to be more support for older people with low-level mental health issues.
- Seven-day working across health and social care, including primary care services needs to be more consistent.
- Priority needs to be given to ensuring a consistent offer of services across the city.