Care services needed to do more to join up

During 2019/20, we saw a greater willingness among services to work together, and a shift in providers’ mindset from being competitive to being more collaborative – acknowledging the benefits and need to work with others to provide joined-up person-centred care and to ensure the specific needs of communities are met. This has been borne out in some of the provider collaboration reviews we did in the summer of 2020, to consider the impact of COVID-19 on services for people aged 65 and over

However, our inspectors and external stakeholders have highlighted the wide variation in collaborative working in all regions, and within local areas. This variation has been seen around the type, purpose, development and implementation of local system working. The differing levels of maturity of system working are due to a number of factors, including the role of commissioning bodies and the strength of working relationships, as well as local characteristics. This could mean the same initiatives – such as primary care networks – might work well in one area but not another. /p>

The national drive for better local system working has been happening for several years and we have pointed to good and bad examples through local system reviews. Some places are better than others, but it is still sometimes difficult to see the impacts for people using services because many system-working initiatives are in their infancy.

The importance of involving people in health and social care planning and decision-making, including around innovation, was recognised.

We have heard examples of good community engagement, where the views and experiences of local people were gathered. However, these examples were not widespread. We have heard concerns from external stakeholders where services are not doing this, and that if people who use services are not involved in local system planning and evaluation, they may not engage with these new ways of working.

We have heard examples of good community engagement, where the views and experiences of local people were gathered. However, these examples were not widespread. We have heard concerns from external stakeholders that if people who use services are not involved in local system planning and evaluation, they may not engage with these new ways of working.

We have seen examples of local developments, partnerships and collaborations in all regions, both within-sector and cross-sector. Within-sector examples include acute trusts working together to solve capacity issues, through sharing services based on clinical need or sharing learning.

Where cross-sector working was taking place, the sectors were working together to address local issues – for example, improving specific patient pathways or relieving pressure points in the system to make life easier for people. We have seen examples of systems to share data and medical records across providers and between sectors, which has increased understanding of performance and demand. However, a lack of access to NHS digital systems can prevent adult social care providers from working with other partners.

In addition, inspectors and external stakeholders reported that adult social care organisations are not always involved as system partners, and that smaller organisations or those with workforce issues can struggle to engage with wider system working.

Although inspectors and external stakeholders have seen large variation in the implementation and impact of primary care networks, they were seen as enabling primary care providers to work together to share resources and offer people better access to services – for example by offering extended opening hours and a wider range of appointments to meet people’s needs. They also provide a basis for working with other organisations, achieving better access to social prescribing, pharmacists, physiotherapy and paramedic support.

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