CQC local system reviews

Featured article - 08 January 2018
By Tony Hunter, SCIE chief executive

Head-shot of the author, Tony Hunter, SCIE chief executive

The Care Quality Commission (CQC) have been carrying out a series of ‘local system reviews’ in areas that are defined by the Department of Health (DH) as having protracted problems around delayed transfers of care.

What the reviews have done thus far is to provide a credible and independent report, often for the first time, around what is really happening within the health and care system, including where the bottlenecks are, and where investment might be needed; and what this means for priority effort across the system in the short, medium and longer term. Significantly, good practice has been found in all areas, alongside problems to be tackled. This shows the complexity of embedding well-working policies and practice in vastly different local circumstances.

Our support offer (commissioned by the DH) has been to work with local areas in using the CQC findings to support focused, well-informed, joined-up discussions at ‘summit meetings’. These have been led by the nominated system lead (in practice usually the health and wellbeing board chair). Working to agendas and practices set at the recent meetings, our offer has been 'critical friend' type advice and engagement from our senior consultants, assisting in the development of detailed, locally-driven and owned action plans. These are submitted a month after the summits. Part of our role has specifically been to link local issues to a range of existing improvement support tools and resources from organisations like the Local Government Association, ADASS, NHS England, NHS Improvement and national agencies such as ourselves and Skills for Care.

As ever, robust relationships are needed across the system with a clear vision; it’s no surprise that these emerge as critical to effective leadership. But, without a shared understanding of what needs tackling to deliver improvement, then even the best leadership can only go so far. In honesty, some of my experience in three localities as director of social services and chief executive was frustration in receiving mixed messages from people in different agencies - and often in the same agency - around what really were the causes of problems rather than just the symptoms.

Well-focused action depends upon that shared analysis and commitment. Without that it’s very difficult for systems to drive improvement. And as our follow-up work is showing, the CQC reviews have, so far, undoubtedly helped build clarity and consensus; and shared momentum.

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