Care staff are dedicated but the health and care system could work better in Oxfordshire, watchdog finds

By Sarah Edwards at

Frontline health and social care staff in Oxfordshire are dedicated and ‘go the extra mile’, according to the national watchdog for health and social care.

The Care Quality Commission (CQC) visited Oxfordshire in November 2017 to carry out one of 20 targeted reviews taking place in England to assess how the whole system of health and social care works together in those areas. The CQC report, published today (Monday 12 February) says:

“People were treated with kindness when they moved between health and social care services. Frontline staff were dedicated and provided person centred care, going the extra mile for people they cared for.

“People, their family and carers told us that they felt well cared for and involved in making decisions about their care, support and treatment when moving through the health and social care system.”

Across all areas of health and social care, a greater than average proportion of Oxfordshire services achieve a good or outstanding CQC rating, which is above the national average.

Areas for improvement

However there remain significant challenges to systematically join up services across organisations in Oxfordshire.

The final report has provided areas of action for senior managers in the NHS, social care and other bodies to act upon to make the whole health and care system work better.

The report has been welcomed by the organisations involved in the review as a positive basis for improvement. All of the CQC’s recommendations for actions have been agreed by the five organisations involved which are:

• Oxfordshire County Council (local authority)
• Oxford Health NHS Foundation Trust (OHFT)
• Oxfordshire Clinical Commissioning Group (OCCG)
• Oxford University Hospitals NHS Foundation Trust (OUHFT)
• South Central Ambulance Service NHS Foundation Trust (SCAS)

The CQC report concludes:

“In Oxfordshire we found that there was a lack of whole system strategic planning and commissioning with little collaboration between system partners.

“Although there was increased ambition to work together system leaders continued to face significant challenges in coming together to formalise their ambitions through a joint strategic approach.”

CQC inspectors found the problems of recruiting care staff in Oxfordshire, which has a very high cost of living, were holding back improvement. Incompatible computer systems also hampered integration of services across the different organisations.

However the inspectors did find that Oxfordshire had make progress in tackling ‘delayed transfers of care’, where people are unable to leave hospital when they are medically fit to do so.

Health and social care leaders agree action plan for improvement

Health and social care leaders from the five organisations involved in the inspection have already met with the CQC to develop an action plan to address the concerns. The key points of the action plan will include:

• Making services more local by using a ‘place-based’ approach to design and delivery of care
• Improving information available to people who fund their own care so they can get the support they need more quickly
• Investing more in recruitment and retention of care staff so more care packages can be delivered, particularly for older people

Oxfordshire health and social care better than England average

The review took place against the backdrop of a variety of care settings in Oxfordshire being rated better by comparison than other areas of England on average.

The CQC rates:

• 88% of social care organisations in Oxfordshire as “Outstanding” or “Good”. (national average 80%)
• 90% of independent health care organisations in Oxfordshire (private hospitals, hospices etc) as “Outstanding” or “Good” (national average 82%)
• 57% of hospitals in Oxfordshire as “Outstanding” or “Good” (national average 51%)
• 98% of primary care services (GP surgeries etc) in Oxfordshire as “Outstanding” or “Good” (national average 96%)

Health and care partners working together to improve

Dr Tony Berendt, Medical Director of Oxford University Hospitals NHS Foundation Trust, said: “I would like to thank all health and social care staff whose kindness, dedication and willingness to go the extra mile for the people in their care has quite rightly been recognised by the Care Quality Commission. As leaders within the health and social care system in Oxfordshire we now need to work together more closely to ensure that we join up the services across the county more effectively.”

Stuart Bell CBE, Chief Executive of Oxford Health NHS Foundation Trust and Chair of the Oxfordshire Transformation Board said: “We are pleased that the Transformation Board was seen to be providing a positive platform to support operational integration and we’re looking at how we as a system can work with the Health and Wellbeing Board to achieve that.”

Kate Terroni, Director for Adult Social Care at Oxfordshire County Council, said:
“Oxfordshire’s health and social care system was one of the first in the country to have pooled budgets and that still works well today. As the report acknowledges, that’s a good platform to build on.

“However, we also know that we are only partway through a journey to improvement and we accept the inspectors’ recommendations. Individual parts of our system work very well. They need to work far better in co-ordination so that we can tackle all of the issues raised in the report and provide seamless services for people in Oxfordshire.”

Louise Patten, Chief Executive of Oxfordshire Clinical Commissioning Group, said: “We very much welcome this report and are pleased to see the hard work of frontline staff has been recognised, with patients reporting that they have been treated with kindness and feel well cared for.

“The report also highlights the areas where we could do better, in particular how different parts of the health and social care system in Oxfordshire could work better together. This is important for everyone – patients, carers and those providing services. We will review the recommendations carefully together and will develop an action plan that will mean patients and residents of Oxfordshire can have confidence that all parts of the health and care system are working together to improve their care.”

Mark Ainsworth, Director of Operations at South Central Ambulance Service NHS Foundation Trust, added: “The CQC Local System Review of Oxfordshire highlights the challenges of the local system and I am confident will become our catalyst for faster transformation to provide better health and social care services for the public of Oxfordshire.

“South Central Ambulance Service is a key member within the system and I look forward to continuing to work closely with our partners to build upon our areas of great innovative work and continue on our journey to providing sustainable health and social care.”

Following the publication of the report, Victoria Prentis MP said:“The lack of a joined-up, forward thinking vision for our local health and social care system has been an ongoing concern for me so the CQC’s findings come as no surprise. We have suffered for too long with a system where providers are reactive not proactive in their decisions, are difficult to communicate with and are unable to articulate a truly innovative plan for the future of healthcare in Oxfordshire. This report is the reality check the system needed.

“The CQC could not have been clearer in their recommendations. We all have a lot of work to do. Going forward, I am hopeful that we will be able to work together collaboratively and constructively to make the long overdue improvements to the direction and delivery of healthcare services across Oxfordshire. I know plans are already underway to improve the Health and Wellbeing Board and I will continue to do what I can to help with that work as it progresses.”