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Oxfordshire health and social care: significant improvements made but more work required says CQC review

9 January 2019
  • Media

The Care Quality Commission has found significant improvements in services for older people in Oxfordshire. 

CQC has published a report on progress made since a local system review of Oxfordshire that was published last year. The review looked specifically at how people move through the health and social care system, with a focus on how hospitals, community health services, GP practices, care homes and homecare agencies work together.

The original review in November 2017 found that there was a strong ambition for partner agencies to work together to provide excellent services to the people of Oxfordshire. The review found that Health and social care professionals were highly dedicated to supporting people using services, their families and carers, although engagement with the public had not always been effective. However, there was a lack of joint strategic planning to tackle some long-standing issues.

The follow up report finds that since the initial review, published in February 2018, partner agencies have worked to change the culture within their organisations and develop better relationships. This had enabled a sense of shared purpose, and a willingness to take a system based approach to resolving challenges and planning for the future. 

Inspectors found solid, practical examples where improved relationships had led to better outcomes for people. For example, work had been undertaken to reduce the numbers of people who remained in hospital unnecessarily. 

Although a workforce strategy had been developed, there was still a need for a system-wide approach staffing in social care and hospitals.

For people who funded their own care, the support, advice and other services remained underdeveloped, and this was recognised by local leaders. Some work had been done to improve access to information for people who fund their own care on the local authority website. However, the planned development of a brokerage service for self-funders had not yet begun. 

System leaders had appointed a winter planning director and joint winter planning had taken place earlier in the year, based on a collaborative approach that included the involvement of voluntary and community sectors, as well as building on experiences from the previous year to improve system capacity. Confidence in the system had increased as a result. 

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

“Our initial review of Oxfordshire’s services found examples of shared approaches but relationships were disjointed and more work was needed to plan and deliver health and social care services for older people. 

“Since that last visit, our inspectors have found system leaders had improved how they work together to co-operate, to plan and deliver health and social care services for older people in Oxfordshire - and while is it not fully developed it is showing signs of improvement.

“We found a stronger strategic approach which allowed for closer working and co-production. Carers’ representatives also felt that engagement had improved and this was demonstrated in the development of the older people’s and Health and Wellbeing Board strategies. We found that the element of partnership working had strengthened and people felt listened to by system leaders.

“This shared approach is so important. System leaders now need to ensure this strategic approach is fully embedded throughout Oxfordshire, so that all staff understand How services can and should work together better for the benefit of people in their care.”


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Last updated:
14 January 2019

Notes to editors


The Oxfordshire local system review looked principally at how people move between services provided by Oxfordshire County Council (local authority), Oxford Health NHS Foundation Trust (OHFT), NHS Oxfordshire Clinical Commissioning Group (OCCG) and Oxford University Hospitals NHS Foundation Trust (OUHT), intermediate care facilities, care homes, a domiciliary care agency, a GP practice, an extra care housing scheme, out-of-hours services and the urgent care centre. 


This follow up review was carried out following a request from the Secretaries of State for Health and Communities and Local Government, following the original 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 several suggestions for the local system in Oxfordshire to improve including:

  • The good work to develop relationships and address cultural change should continue and be embedded throughout the Oxfordshire health and social care system to improve the quality of services for older people in Oxfordshire. The older people’s strategy should be agreed and implemented. 
  • Good work to develop relationships and address cultural change should be embedded throughout Oxfordshire’s health and social care systems. This should include engagement with the VCSE sector and independent providers. 
  • Timescales and targets for service delivery should be more ambitious to improve the pace of transformation. This includes plans such as the rollout of the continuing healthcare service specification. Reviews and evaluations of projects and pilots should be translated into decision-making and wider delivery where appropriate. 
  • The draft workforce strategy for Oxfordshire should be agreed with the STP and implemented at pace, including the work with independent social care providers to support a sustainable workforce. 
  • The comprehensive review of pathways of care should be undertaken. Discharge to assess processes should be evaluated and streamlined to move away from bed-based assessments where possible. Housing needs, particularly with regard to equipment and adaptations should be addressed as part of this review. 
  • Further organisation development work should be undertaken to address the culture of frontline staff, particularly medical staff, to enable a strength-based approach to care planning. 
  • Support for carers and for people who fund their own care should be developed, particularly regarding plans for the brokerage system which needed to be allocated deliverable timescales. 

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.