As part of the Care Quality Commissions (CQC) work to develop a new regulatory assessment for Integrated Care Systems (ICS) in England, Healthwatch Lincolnshire is pleased to present this report which contains detailed information about our engagement approach and findings from both the public and health and care leaders in Lincolnshire.
Lincolnshire covers one large geographical ICS footprint which includes both urban and rural conurbations. Lincolnshire has it all from the city of Lincoln with the usual mix of affluence and deprivation, through to coastal complexities and some of the most rural areas in England. Local health Trusts who have struggled for many years, their challenges only exacerbated by the ever-declining workforce, poor travel infrastructures and local expectations of care all gave our work richness and tales to tell.
When starting this work, we were aware that many of our NHS services are still feeling the impact of Covid-19 and only just experiencing green shoot recovery. For many patients, carers and service users, their view of Covid-19 on how they access services has changed from support and understanding, through to concern and often anger about the impact on their health where they feel services are ‘not available’.
Throughout the engagement work we completed between April and May 2022, including surveys, group work and one to one interviews, the areas that mattered most to people were being treated holistically (person centred care); more effective and appropriate communication and services being more joined up (talking to one another).
Our health and care leaders told us they were fully committed to embedding patient, carer and service user experiences in service redesign and decision making but recognised there is a lot to be done by everyone to meaningfully achieve this. This was reinforced by the overwhelming response to our public and seldom heard question ‘Do you feel your experience of health and social care are activity taken into consideration in helping to shape future services – overwhelmingly the response was NO.
What evidence will CQC require from providers and commissioners?
- Engagement strategy – with performance against action plan
- Communications strategy – with performance against action plan
- Accessible Information Standards (AIS) Strategy – and examples of where these are being met
- Patient feedback – what systems are in place to show feedback is joined up across ICS. In an effective ICS, it will be vitally important not to focus just on the performance of individual services but also the efficiency and effectiveness of the interface between services and providers
- Equality Impact Assessment – examples from service redesign as a minimum
- ICB Board performance reports – these should be provided and collated for a 12-month period to enable monitoring of performance
- Whistleblowing policy – including examples of information shared which should be logged on a register
- Never event/Serious Incident logs – should provide evidence of how these are dealt with, how lessons learned are shared
- Care plans e.g., Anticipatory Care Plans, Advanced Care Planning – examining a random selection of plans to check if these are appropriately in place, include the persons own desired outcomes and are up to date.
- Waiting times for diagnostics, elective care – including number of people on the lists, how people are triaged to ensure ‘high risk’ patient needs are being dealt with.
- ICS partner agreements – these would demonstrate real ‘commitment to integrated working’ from all providers, commissioners and stakeholders involved in local ICS.
From the information shared with us, more work needs to be done to ensure people’s experiences are really at the heart of service redesign and decision making. More work is also needed to enable people to ‘speak out’ and be heard. These are areas that we are sure CQC will want to focus on when regulating how well our Integrated Care Systems are meeting the needs of local people and communities, and most importantly ensuring ICS are delivering positive health and care outcomes for patients, service users and their carers.