The Quality of Care in North Lincolnshire the Quality of Care in Salford Prototype Report (Greater Manchester) (February 2016) Prototype Report (May 2016)
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THE QUALITY OF CARE IN North Lincolnshire CQC prototype report February 2016 Quality of care in a place Quality of care in a place The Care Quality Commission is producing a number of prototype documents exploring how we might report on the quality of care in a place. The following documents are planned for the first half of 2016. The quality of care in North Lincolnshire The quality of care in Salford Prototype report (Greater Manchester) (February 2016) Prototype report (May 2016) North Lincolnshire Tameside (Greater Manchester) Data only report Data only report (February 2016) (May 2016) THE QUALITY OF CARE IN NORTH LINCOLNSHIRE – PROTOTYPE REPORT Contents QUALITY OF CARE IN A PLACE ........................................................................................... 2 CONTENTS ............................................................................................................................. 1 FOREWORD ............................................................................................................................ 3 SUMMARY .............................................................................................................................. 5 Providers .................................................................................................................................... 5 Health and wellbeing .................................................................................................................. 5 Impact of partnerships ................................................................................................................ 6 Governance and commissioning ................................................................................................ 8 Challenges and opportunities ..................................................................................................... 8 INTRODUCTION ................................................................................................................... 10 Our approach ........................................................................................................................... 12 Reading the data in this prototype report .................................................................................. 14 The way forward ...................................................................................................................... 15 NORTH LINCOLNSHIRE OVERVIEW .................................................................................. 16 1. THE QUALITY OF HEALTH AND SOCIAL CARE ........................................................... 18 1.1 Providers ......................................................................................................................... 19 1.2 Adult social care .............................................................................................................. 20 1.3 Primary care (including community health services, GP and out-of-hours, urgent care and dentists) ................................................................................................................................... 23 1.4 Acute care ....................................................................................................................... 24 1.5 Mental health care .......................................................................................................... 28 2. POPULATIONS AND THEIR EXPERIENCES .................................................................. 29 2.1 Health and care outcomes .............................................................................................. 29 2.2 Person-centred and coordinated care; health and social care integration ........................ 33 2.3 What people say ............................................................................................................. 39 2.4 People experiencing poor mental health and older people .............................................. 43 2.5 Inequalities ...................................................................................................................... 51 3. SYSTEMS AND THEIR IMPACT ....................................................................................... 55 3.1 Leadership ...................................................................................................................... 55 3.2 Protecting people from harm and abuse.......................................................................... 64 THE QUALITY OF CARE IN NORTH LINCOLNSHIRE – PROTOTYPE REPORT 1 Contents 3.3 The impact of governance ............................................................................................... 66 3.4 The impact of commissioning .......................................................................................... 70 3.5 Workforce capacity and capability ................................................................................... 75 4. BRINGING IT ALL TOGETHER ........................................................................................ 79 Reflections ............................................................................................................................... 80 Other considerations ................................................................................................................ 81 APPENDIX: COMPLETE LIST OF KEY LINES OF ENQUIRY ............................................. 82 2 THE QUALITY OF CARE IN NORTH LINCOLNSHIRE – PROTOTYPE REPORT Foreword Foreword The Care Quality Commission’s (CQC’s) purpose is to make sure health and social care services provide people with safe, effective, compassionate, high- quality care and to encourage care services to improve. This prototype report is the first output from our programme of work to explore the role of CQC in quality regulation in a local area. Our approach tests whether going beyond the regulation of individual providers helps us to achieve our purpose. Reporting on the quality of care in a place is the next step in understanding how CQC can contribute to discussions about quality beyond individual providers. There are a number of other reports which will be produced over the next few months which will also help to shape our thinking. In spring we will evaluate this work to understand which approaches are best to take forward. We will do this in a way that effectively balances the changing nature of health and social care provision with the need to ensure CQC continues to provide robust and transparent ratings of providers. The health and care landscape is rapidly changing, and we are working hard to ensure that CQC is an enabler of progress. A shared focus on the full health and care needs of individuals is vital to ensure people receive high-quality care. We will continue to work to develop our understanding of how CQC can help to facilitate this. The objectives of this Quality in a Place programme are to understand the extent to which we can provide evidence to support whether reporting on the quality of care in a place can be a lever for improvement. The evaluation that will be produced alongside our reports and your feedback will help inform our thinking about how to regulate new care models such as accountable care THE QUALITY OF CARE IN NORTH LINCOLNSHIRE – PROTOTYPE REPORT 3 Foreword organisations (ACOs) and whether reporting in this way has the potential to improve transparency for people living in a local area. This prototype report is designed as a compendium of what we have learned about North Lincolnshire and we are very grateful to the stakeholders for being so generous with their time. This is not a typical CQC report – it tells the story, but does not aim to reach a conclusion on the quality of care in North Lincolnshire. Reaching a conclusion would not be appropriate at this stage in the development of this work. I would welcome your thoughts and feedback on this first prototype report. We will seek to continue to engage with stakeholders, both local and national, over the coming months as we launch more reports and finalise our 2016-21 strategy. David Behan Chief Executive 4 THE QUALITY OF CARE IN NORTH LINCOLNSHIRE – PROTOTYPE REPORT Summary Summary PROVIDERS The quality of providers in North Lincolnshire is broadly in line with the national picture across England. However, this needs to be considered in context as in August 2015 when the data was produced to inform the site, we had not yet inspected and rated the majority of providers. At this point we had not identified any outstanding or inadequate providers in the area. By August 2015 we had inspected and rated 33 out of 77 adult social care providers in North Lincolnshire. The majority of these providers were rated good, which was potentially better than England overall – 73% of inspected providers were good compared with 60% for England. However, given that we had inspected and rated less than half of adult social care providers both in North Lincolnshire and nationally, this comparison should be treated with caution. It is more difficult to draw conclusions about the quality of acute care as the main acute hospital provider was recently re-inspected. The outcome will be known this month. Historically it has been in special measures and was rated as requires improvement overall in 2014. Six out of 20 GP practices in North Lincolnshire have been rated: five are good, and one requires improvement. HEALTH AND WELLBEING North Lincolnshire is ranked 129th out of 326 in England’s local authority deprivation index which