CQC did some reviews of local areas in 2020 and 2021. They looked at the way health and social care services worked together. These were called provider collaboration reviews (PCRs).
We wanted to know how providers were working together. The focus was on integrated care systems and sustainability and transformation partnerships.
Our reviews happened between July 2020 and November 2021 and there were five topics:
- Care for older people
- Urgent and emergency care
- Cancer care services and pathways
- Services for people who live with a learning disability in the community
- Services for children and young people who have a mental health condition
Most reviews looked at inequalities and there was a focus on different ethnic groups.
We have done our own evaluation of the reviews. This is to understand if they were effective at capturing and sharing learning. Also, we wanted to know how they might help improvement.
How we gathered evidence for the evaluation
- Focus groups and interviews with our own people who were involved in the reviews, including clinical and specialist advisers.
- Interviews with system partners who participated in reviews (reviews 1 and 2)
- Survey of system partners who participated in all reviews
- Website statistics and engagement data relating to published reports
- Literature scan of studies relating to regulatory approaches in systems.
Findings
The reviews were good at finding out how systems were learning. Feedback from systems told us the information we reported was fair and accurate.
Most systems told us they liked the way we worked with them during the reviews. Systems told us they valued the working relationship with CQC including how the reviews were set-up and undertaken.
Many people we asked were positive about the detailed interviews we used to look at local services and how they work together. Structured conversations with a selection of people from across systems and at all levels helped us to understand how providers were working together. We heard that our use of data helped our understanding of systems and provided context to the findings.
Some people thought the scope of the reviews was a barrier to identifying learning and influencing improvement. Some said the scope was too narrow, others thought it was too broad. People thought it affected our ability to capture information about system working in enough detail in some areas. In our reviews, we did not consider the way services are bought, which is known as commissioning.
We did not have enough feedback from people who use services for the first two reviews. We improved this as the reviews went on, but we did not always get enough detailed information.
We heard that our focus on health inequalities encouraged systems to think about how these issues could be addressed in their area. Some systems were not as far along in their thinking as others and so our focus helped systems to consider inequalities as a key topic.
We have seen examples of where PCR findings contributed to changes and improvements in systems. However, the findings did not always lead to specific actions. We were told this was due to the timing of the feedback being shared and the high-level of some of our recommendations.
We heard from systems that the reviews were an opportunity to reflect on their performance. Findings from the reviews were often already known to systems, but we were told this offered confirmation or validation of their approach and it was helpful. Some systems told us taking part in the review was a positive experience because it showed the things they were doing well.
Conversations with system partners also highlighted the complex factors that affect their performance as a system, including their maturity and capacity. Our evaluation findings have been considered within CQC and will help inform conversations about our future assessment of systems.
What next?
The findings from the evaluation have been shared with CQC’s Research, Development and Evaluation Committee and with the Executive Team and will inform decisions relating to our future assessment of systems.
The Research & Evaluation team would like to thank system partners and internal colleagues who took the time to offer feedback as part of the evaluation.