In this Account Commission briefing about Scotland’s Integration Joint Boards (IJBs), we report that community health and social care faces rising unmet need and managing the crisis is taking priority over prevention due to the multiple pressures facing the bodies providing these services.
IJBs plan and commission many vital community-based health and care services.
People
One in 25 people in Scotland receive social care.
Expected to rise sharply due to an ageing population – 76% of people receiving health and social care are aged 65 and over.
By mid-2045, the number of people aged 65 and over is set to grow by nearly a third.
Performance
Where data is available, nationally there has been a general decline in performance of services and outcomes for people.
Data quality and availability is insufficient to fully assess the performance of IJBs and inform how to improve outcomes for people who use services with a lack of joined- up data sharing.
Care
Community health and social care faces unprecedented pressures and financial uncertainty. We have not seen significant evidence of the shift in the balance of care from hospitals to the community intended by the creation of IJBs.
Finances
IJB funding has decreased by £1.1 billion (nine per cent) in real terms to £11 billion in 2022/23. The funding gap is set to triple in 2023/24.
IJBs are making savings by not filling staff vacancies and using their financial reserves, but this is not sustainable.
Staffing
Vacancies are at a record high. Nearly half of services report vacancies. A quarter of staff leave jobs within their first three months. And there is continued turnover in senior leadership.
Action is needed now
IJBS need to share learning to identify and develop:
- service redesign focused on early intervention and prevention.
- approaches focused on improving the recruitment and retention of the workforce.
- improvement to the data available.
- commissioning approaches that improve outcomes for people.
- ensure that their financial plans are up to date.
IJBs need to work together and with other stakeholders to:
- ensure that the annual budgets and proposed savings are achievable and sustainable.
MEANWHILE, DOWN SOUTH …
ENGLAND’S SOCIAL CARE WATCHDOG ‘NOT FIT FOR PURPOSE
The Care Quality Commission (CQC), the body responsible for regulating adult social care services in England, is ‘not fit for purpose’, according to the health secretary Wes Streeting.
Health and Social Care Secretary Wes Streeting was responding to an independent review that identified ‘significant internal failings’ within the health and social care regulator.
The interim report, led by Dr Penny Dash, chair of the North West London Integrated Care Board, found the number of inspections being undertaken were well below pre-Covid levels.
It also revealed a lack of clinical expertise among inspectors, a lack of consistency in assessments and problems with the CQC’s IT system.
Commenting on her findings, Dr Dash said: ‘The contents of my interim report underscore the urgent need for comprehensive reform within the CQC.
‘By addressing these failings together, we can enhance the regulator’s ability to inspect and rate the safety and quality of health and social care services across England.’
Mr Streeting commented: ‘When I joined the department, it was already clear that the NHS was broken and the social care system in crisis.
‘But I have been stunned by the extent of the failings of the institution that is supposed to identify and act on failings. It’s clear to me the CQC is not fit for purpose.’ Kate Terroni, CQC’s interim chief executive, said the regulator accepts in full the findings and recommendations of the report.
‘Many of these align with areas we have prioritised as part of our work to restore trust with the public and providers by listening better, working together more collaboratively and being honest about what we’ve got wrong,’ she said.
‘We are working at pace and in consultation with our stakeholders to rebuild that trust and become the strong, credible, and effective regulator of health and care services that the public and providers need and deserve.’
The interim findings of the review of our operational effectiveness led by Dr Penelope Dash have been published this morning. In response, Kate Terroni, our interim chief executive, said: “We accept in full the findings and recommendations in this interim review, which identifies clear areas where improvement is urgently needed.
“Many of these align with areas we have prioritised as part of our work to restore trust with the public and providers by listening better, working together more collaboratively and being honest about what we’ve got wrong.
“We are working at pace and in consultation with our stakeholders to rebuild that trust and become the strong, credible, and effective regulator of health and care services that the public and providers need and deserve.
“Work is underway to improve how we’re using our new regulatory approach. We’ve committed to increasing the number of inspections we are doing so that the public have an up-to-date understanding of quality and providers are able to demonstrate improvement.
“We’re increasing the number of people working in registration so we can improve waiting times. We’re working to fix and improve our provider portal, and this time we’ll be listening to providers and to our colleagues about the improvements that are needed and how we can design solutions together.
“We’ll be working with people who use services and providers to develop a shared definition of what good care looks like. And we’re also developing a new approach to relationship management that enables a closer and more consistent contact point for providers.
“Additionally, to strengthen our senior level healthcare expertise, we have appointed Professor Sir Mike Richards to conduct a targeted review of how the single assessment framework is currently working for NHS trusts and where we can make improvements.
“Sir Mike’s career as a senior clinician, and a distinguished leader of high-profile national reviews, as well as his direct experience of driving improvement through regulation, make him uniquely placed to conduct this work.”
The interim findings of the review have been published on GOV.UK.
