National Care Service - keeping care support local part 2 – community health care: regional forums - findings summary

What we learned

We asked people who attended to tell us what they thought of the approach to community health we have developed. People told us we should:

• make reference to the third sector - participants were concerned that social care and third sector organisations were being forgotten about when it comes to community health
• change the ordering of paragraphs to make it easier to read
• remove jargon and defining terms to make it clearer

The second activity was about common scenarios in social care. A number of key themes were highlighted across all three geographic locations and the online sessions: Culture, Governance, Information Sharing and Resources. These themes are not limited to community health and the findings will be shared across other themes to maximise use.

Culture

Culture and the need for continuous improvement were discussed in detail at all events. This included both workforce culture and person-centred care. People were very passionate when talking about culture both in terms of what is working well and also the areas they feel could be improved. These included:

Communication:

• the need to improve the way services communicate with each other to help improve the co-ordination of services. People said that it was important for professionals to understand what services are available in an area and the benefits of each service
• It was noted that connections to services can be lost when members of the workforce change roles and there is therefore a need to develop a more robust system for maintaining awareness of services
• making sure open, honest and transparent communication played a part in improving culture

Collaboration:

• people highlighted the challenge of working across two separate systems (health and social care) and the impact this had on continuity of care for people accessing services
• this was particularly emphasised in relation to child and adolescent mental health services (CAMHS) and children’s services.
• people noted that in some areas multi-disciplinary teams were located in the same space which helped people understand their different disciplines and work together better
• People thought that putting effort into developing shared values was important in improving the culture in multi-disciplinary teams where not all workers report to the same employer.
• People told us it was important to look beyond the National Care Service and understand the interaction of workforce culture with the NHS, third sector and independent sector to ensure that we are developing good working relationships and open, honest and transparent communication to ultimately deliver person-centred care.

Person centred care:

• Attendees were passionate about the importance of a culture of person-centred care
• The importance of early intervention was highlighted
• Some people felt that proper support and access to services only really occurs when people are at the crisis stage
• People wanted more involvement in early intervention to prevent people’s care needs escalating
• The need for advocacy to facilitate person-centred care was highlighted by healthcare providers and unpaid carers. There was discussion around advocacy to support the person needing care to help them socialise their experience, especially where they are unable to do so themselves.
• People also highlighted the need for people to have access to advocates, especially where there might be a conflict between person-centred care and the easiest option for services, or to challenge professional opinion when it is at odds with the person’s preferences.

Transitions between children’s and adult services:

• People talked about the benefits of transition teams and the need for joint service transition meetings which could help the development of personalised plans.
• The need for parental and individual engagement in the development of these plans was considered important.
• Service users and the people who support them need good information and support to understand the differences between adult and children’s services was also considered as a requirement.
• Some people thought the rigidity with which the age for engaging with adult services is enforced by the NHS was problematic and they suggested that transitions needed to be planned for early and progressed at a person-centred pace.

Governance

The need for improved governance was raised as one of the main ways to reduce the variation in community health and social care services.

Governance was discussed in each of the events with key themes emerging. They included:

• accountability – making sure everybody in the care journey understands their responsibilities
• transparency – specifically between services to support co-ordination
• responsibility – who and what

Accountability

People raised the benefits of accountability:

• as community health and social care are influenced by numerous factors outside health and social care settings, efforts to understand accountability and roles and responsibilities will help ensure community health and social care services deliver as intended
• if each individual and organisation understands their accountability this builds trust and manages expectations
• people thought rather than a change to the current system this could simply be an improvement and ‘enhancing what we already have’
• shadowing opportunities would help staff understand the systems and practice of other services and care disciplines
• legislation was discussed as a method to ensure accountability and assign statutory responsibility

Transparency

People explored the importance of transparency, noting that:

• there are lots of examples of good transparency between organisations but this is often dependent on the workforce building and maintaining open lines of communication and trust
• there is a lack of consistency in policies and training for staff so people, agencies, and organisations don’t know how to talk to each other
• improving communication amongst organisations and a method for sharing good practice would help
• some people also suggested the development of a central source of information that would allow the workforce to search for services and service availability in their local area so that they could signpost or refer service users to them, dependent on their needs
• people said it was important this was kept up to date and accurate

Information sharing

People at the sessions discussed information sharing, both in terms of information being shared between service providers and also information about available services.

People said there are excellent services but if the person or care provider is unaware of them, or does not have the information available to share, then people will miss out on available support.

Other themes that came up around information sharing included:

• person-led information – people talked about the variety of systems that are used in the NHS and said this makes it hard to share information across them
• people wanted better ways for people’s information to be shared between services
• service information – people said it was important that accurate and up to date information about local services and how to access them was available for staff and for people accessing support, and shared some examples of where this was happening
• they said it was important that this information was maintained at a local level
• people want to see the right information systems in place to make sure information sharing can happen
• the benefit of technology was also discussed in relation to accessing services, people said that following on from Covid-19 they have learned to use technology to their advantage
• people in rural areas are using digital technologies to provide access improvements to specialists in remote and rural locations that was not previously available.
• however, there was recognition that providing care via technology is not always the most appropriate method.
• people working in mental health highlighted the challenge some of their service users may have with using technology and the frustration that this was often their only route to receiving care and support.
• the cost of IT and the need for upskilling the workforce and providing relevant training was highlighted.

Resources

The importance of having enough people and financial resource to drive improvements was a common theme in discussions.

People discussed the impact of resourcing on:

• recruitment and retention – staff shortages and recruitment challenges led to limited services
• pay – specifically the challenges around consistent pay across different sectors

People talked about:

• staff shortages having a knock on effect, with other services accommodating the shortfall to try to help the person requiring support
• staff shortages impacting people accessing services with long waiting lists, challenges accessing services, and people’s needs going unmet in the community identified as the main issues
• people talked about differences in pay scales made it harder for some organisations to recruit and retain staff
• people suggested a number of ways to improve recruitment and retention of staff such as longer term contracts, better alignment of pay scales across organisations and investment and opportunities for training and education.
• people agreed that better funding was needed to improve services
• people also thought that more investment in early interventions and preventative support was needed to improve outcomes for people