This review draws on one hundred inspections of care homes in England to examine oral health in care homes, with specific reference to the NICE guideline NG 48 on oral health for adults in care homes. It includes direct quotations from managers, staff and people using services and their relatives. It also includes good practice examples to highlight the benefits of good oral care for older people, people with learning disabilities and people living with dementia. The review found that staff awareness of the NICE guideline recommendations was low, over half of care homes visited had no policy to promote and protect people’s oral health, and nearly half of care homes were not providing staff training to support people’s daily oral healthcare. The review also identified challenges such as: a lack of dentists who were able or willing to visit care homes and local dentists not accepting new patients and the length of time it took to get an appointment with an NHS dentist. The report recommends mandatory staff training in oral care, oral health check-ups for all residents upon admission, better signposting to local dental services and awareness raising.
(Edited publisher abstract)
This review draws on one hundred inspections of care homes in England to examine oral health in care homes, with specific reference to the NICE guideline NG 48 on oral health for adults in care homes. It includes direct quotations from managers, staff and people using services and their relatives. It also includes good practice examples to highlight the benefits of good oral care for older people, people with learning disabilities and people living with dementia. The review found that staff awareness of the NICE guideline recommendations was low, over half of care homes visited had no policy to promote and protect people’s oral health, and nearly half of care homes were not providing staff training to support people’s daily oral healthcare. The review also identified challenges such as: a lack of dentists who were able or willing to visit care homes and local dentists not accepting new patients and the length of time it took to get an appointment with an NHS dentist. The report recommends mandatory staff training in oral care, oral health check-ups for all residents upon admission, better signposting to local dental services and awareness raising.
(Edited publisher abstract)
Subject terms:
care homes, adults, older people, oral health, policy, care planning, learning disabilities, dementia, good practice, inspection;
The findings of a targeted local system review of health and social care services in Leeds, looking at how older people move through the care system, with a focus on how services work together. The review focuses on three areas: supporting people at home, care and support when people experience a crisis and hospital discharge. It gathered feedback from a range of people including those responsible for directly delivering care, as well as people who use services, their families and carers. CQC reviewers identified a good voluntary, community and social enterprise sector in Leeds with many opportunities for people to receive support, particularly for people at risk of social isolation and loneliness. Initiatives included investment in community based Neighbourhood Networks and multidisciplinary Neighbourhood Teams to help people remain well at home. The review found that when older people attended hospital, there was a higher chance than the England average that they would be admitted, and once people were admitted it was difficult for them to return home with support. Some areas of good practice were also identified, including the provision of 227 community care beds across the city as a responses to delayed discharges and the pressure of bed occupancy. The report concludes that system leaders in Leeds had a shared vision that was supported and understood across health and social care organisations, with a shared understanding of the challenges ahead. The review identifies some potential areas for improvement, which include for continued work to reduce hospital admissions and the development evaluations and exit plans for people who had benefitted from support in the community.
(Edited publisher abstract)
The findings of a targeted local system review of health and social care services in Leeds, looking at how older people move through the care system, with a focus on how services work together. The review focuses on three areas: supporting people at home, care and support when people experience a crisis and hospital discharge. It gathered feedback from a range of people including those responsible for directly delivering care, as well as people who use services, their families and carers. CQC reviewers identified a good voluntary, community and social enterprise sector in Leeds with many opportunities for people to receive support, particularly for people at risk of social isolation and loneliness. Initiatives included investment in community based Neighbourhood Networks and multidisciplinary Neighbourhood Teams to help people remain well at home. The review found that when older people attended hospital, there was a higher chance than the England average that they would be admitted, and once people were admitted it was difficult for them to return home with support. Some areas of good practice were also identified, including the provision of 227 community care beds across the city as a responses to delayed discharges and the pressure of bed occupancy. The report concludes that system leaders in Leeds had a shared vision that was supported and understood across health and social care organisations, with a shared understanding of the challenges ahead. The review identifies some potential areas for improvement, which include for continued work to reduce hospital admissions and the development evaluations and exit plans for people who had benefitted from support in the community.
(Edited publisher abstract)
Subject terms:
older people, prevention, commissioning, health care, hospital discharge, inspection, integrated care, social care provision, leadership;
The findings of a targeted local system review of Staffordshire, looking at how older people move through the health and social care system, with a focus on how services work together. It focuses on three areas: supporting people at home; care and support when people experience a crisis; and hospital discharge. The review gathered feedback from a range of people including those responsible for directly delivering care, as well as people who use services, their families and carers. The review found that although there was a shared vision from leadership in the county’s Sustainability and Transformation Partnership (STP), but that this did not transfer to those at an operational level. Overall CQC reviews found that older people living in Staffordshire had varied experiences of health and social care services, and that there were variations in what was available to them depending on where they live; there were instances of people attending A&E because they couldn't get GP appointments; A&E attendance for people over 65 living in care homes were higher than both national and comparator areas; there were also delays in older people being discharged from hospital. The review also identified examples of good practice, for example people were being supported to remain in their own home through services coordinated through a GP practice hub model. The review makes a number of suggestions for improvement: further development of a whole county joint commissioning strategy to enable consistency of provision throughout Staffordshire; the development of a whole county dementia strategy; and the rolling out of nationally validated models of GP support for care homes.
(Edited publisher abstract)
The findings of a targeted local system review of Staffordshire, looking at how older people move through the health and social care system, with a focus on how services work together. It focuses on three areas: supporting people at home; care and support when people experience a crisis; and hospital discharge. The review gathered feedback from a range of people including those responsible for directly delivering care, as well as people who use services, their families and carers. The review found that although there was a shared vision from leadership in the county’s Sustainability and Transformation Partnership (STP), but that this did not transfer to those at an operational level. Overall CQC reviews found that older people living in Staffordshire had varied experiences of health and social care services, and that there were variations in what was available to them depending on where they live; there were instances of people attending A&E because they couldn't get GP appointments; A&E attendance for people over 65 living in care homes were higher than both national and comparator areas; there were also delays in older people being discharged from hospital. The review also identified examples of good practice, for example people were being supported to remain in their own home through services coordinated through a GP practice hub model. The review makes a number of suggestions for improvement: further development of a whole county joint commissioning strategy to enable consistency of provision throughout Staffordshire; the development of a whole county dementia strategy; and the rolling out of nationally validated models of GP support for care homes.
(Edited publisher abstract)
Subject terms:
inspection, older people, integrated care, commissioning, hospital discharge, prevention, leadership, social care provision, health care;
CARE QUALITY COMMISSION, HM INSPECTORATE OF PRISONS
Publisher:
HM Inspectorate of Prisons
Publication year:
2018
Pagination:
43
Place of publication:
London
This joint review looks at the provision of social care in prisons following the introduction of new social care services to prisoners under the Care Act 2014 and the Social Services and Well-Being (Wales) Act 2014. It draws on inspection reports and additional data collection conducted in eight establishments. Although the review identified developments that are good practice in the social care of prisoners, it found a wide variation and disparity in the provision of social care services in prisons. Many older jails are ill-equipped for prisoners in wheelchairs or with mobility problems. Some prisoners also struggle to wash and look after themselves. The report also shows a failure of the prison service and local authorities to plan for the future needs of a growing population of older and frail prisoners, with developments in social care in prisons only relating to current levels of need. The report makes recommendations for prisons and local authorities in relation to strategic planning, needs assessment, care planning, adapting the physical environment, and continuity of care when prisoners are transferred or released into the community.
(Edited publisher abstract)
This joint review looks at the provision of social care in prisons following the introduction of new social care services to prisoners under the Care Act 2014 and the Social Services and Well-Being (Wales) Act 2014. It draws on inspection reports and additional data collection conducted in eight establishments. Although the review identified developments that are good practice in the social care of prisoners, it found a wide variation and disparity in the provision of social care services in prisons. Many older jails are ill-equipped for prisoners in wheelchairs or with mobility problems. Some prisoners also struggle to wash and look after themselves. The report also shows a failure of the prison service and local authorities to plan for the future needs of a growing population of older and frail prisoners, with developments in social care in prisons only relating to current levels of need. The report makes recommendations for prisons and local authorities in relation to strategic planning, needs assessment, care planning, adapting the physical environment, and continuity of care when prisoners are transferred or released into the community.
(Edited publisher abstract)
Subject terms:
prisons, social care provision, older people, needs, prisoners, local authorities, mobility impairment, inspection, planning, ageing;
This report is one of 20 targeted reviews of local authority areas looking specifically at how older people move through the health and social care system, with a focus on how services work together. It reviews how the system functions within and across three key areas: maintaining the wellbeing of a person in their usual place of residence, crisis management and step down, return to usual place of residence and/or admission to a new place of residence. The review found Stockport had a well-defined strategic vision for health and social care, with the five main health and social care organisations in Stockport working in partnership through the ‘Stockport Together programme’. It found examples of good initiatives to meet people’s needs and prevent admission to hospital, such as the Neighbourhood Care Model, a multi-disciplinary approach to case management incorporating GP support. It also found a commitment from all levels of staff to provide person-centred care, reduce isolation and to empower people to make decisions about their care and support needs. However, older people requiring emergency hospital admission could experience waits in A&E and were more likely to remain in hospital longer than required, often due to a shortage of homecare packages or the availability of residential care. There were also significant pressures in recruiting and retaining a sufficient workforce. Recommendations include: that care home and home care providers are better involved in the planning of hospital discharges; that the system should embed the High Impact Change model to reduce the need for people to remain in hospital longer than necessary; and for independent adult social care providers to be included in the development of the workforce strategy, to improve recruitment and retention.
(Edited publisher abstract)
This report is one of 20 targeted reviews of local authority areas looking specifically at how older people move through the health and social care system, with a focus on how services work together. It reviews how the system functions within and across three key areas: maintaining the wellbeing of a person in their usual place of residence, crisis management and step down, return to usual place of residence and/or admission to a new place of residence. The review found Stockport had a well-defined strategic vision for health and social care, with the five main health and social care organisations in Stockport working in partnership through the ‘Stockport Together programme’. It found examples of good initiatives to meet people’s needs and prevent admission to hospital, such as the Neighbourhood Care Model, a multi-disciplinary approach to case management incorporating GP support. It also found a commitment from all levels of staff to provide person-centred care, reduce isolation and to empower people to make decisions about their care and support needs. However, older people requiring emergency hospital admission could experience waits in A&E and were more likely to remain in hospital longer than required, often due to a shortage of homecare packages or the availability of residential care. There were also significant pressures in recruiting and retaining a sufficient workforce. Recommendations include: that care home and home care providers are better involved in the planning of hospital discharges; that the system should embed the High Impact Change model to reduce the need for people to remain in hospital longer than necessary; and for independent adult social care providers to be included in the development of the workforce strategy, to improve recruitment and retention.
(Edited publisher abstract)
One of 20 targeted local system reviews looking specifically at how older people move through the health and social care system, with a focus on how services work together. The review found there was a system-wide commitment to serving the people of Birmingham, but that services had not always worked effectively together. It highlighted a number of areas where improvements are needed to ensure those responsible for providing health and social care services work better together. Overall, the review found that peoples’ experience of health and social care was variable and access and availability of services was inconsistent across the city. Fewer people had the chance to exercise choice and control over their care and support - some were offered care placements in parts of the city that were not accessible to their families; some were admitted to hospital with social care needs that could have been managed more effectively and safely at home; and some people stayed in hospital for longer than they needed to. The review also found that more could be done to engage diverse communities in the planning and delivery of services to ensure that services met the specific cultural and health needs of local populations. In addition, there was not a systematic and joined up approach across the city to using feedback from people, their families and carers, about services being provided. Suggested areas for improvement include: for the system’s leadership to build on recent improvements in relationships and organisational structures by strengthening relationships, improving communication and ensuring there is a shared understanding among staff of their role in achieving the strategic vision at an operational level; and improving information sharing across health and social care, as this has proved a barrier to integrated working.
(Edited publisher abstract)
One of 20 targeted local system reviews looking specifically at how older people move through the health and social care system, with a focus on how services work together. The review found there was a system-wide commitment to serving the people of Birmingham, but that services had not always worked effectively together. It highlighted a number of areas where improvements are needed to ensure those responsible for providing health and social care services work better together. Overall, the review found that peoples’ experience of health and social care was variable and access and availability of services was inconsistent across the city. Fewer people had the chance to exercise choice and control over their care and support - some were offered care placements in parts of the city that were not accessible to their families; some were admitted to hospital with social care needs that could have been managed more effectively and safely at home; and some people stayed in hospital for longer than they needed to. The review also found that more could be done to engage diverse communities in the planning and delivery of services to ensure that services met the specific cultural and health needs of local populations. In addition, there was not a systematic and joined up approach across the city to using feedback from people, their families and carers, about services being provided. Suggested areas for improvement include: for the system’s leadership to build on recent improvements in relationships and organisational structures by strengthening relationships, improving communication and ensuring there is a shared understanding among staff of their role in achieving the strategic vision at an operational level; and improving information sharing across health and social care, as this has proved a barrier to integrated working.
(Edited publisher abstract)
Subject terms:
integrated care, older people, interagency cooperation, prevention, hospital admission, hospital discharge, access to services, joint working, commissioning, co-production;
One of 20 targeted reviews of local authority areas looking at how older people move through the health and social care system, with a focus on how services work together. Specifically, it reviews how the local system is functioning within and across three areas: maintaining the wellbeing of a person in their usual place of residence, crisis management, and step down, return to usual place of residence and/ or admission to a new place of residence. The review found there was a clear shared and agreed purpose, vision and strategy described in the Happy, Healthy at Home plan, which was articulated throughout all levels of the system. Most staff were committed to the vision and agencies were also working together to keep older people safe at home rather than hospital. Reviewers also identified examples of some good joined up interagency processes, particularly the Bradford Enablement Support Team (BEST) for reablement, the MAIDT (multi-agency integrated discharge team) and The MESH team (the medicines service at home). Overall, people who lived in Bradford were supported to live in their own homes and their communities for as long as possible and received holistic assessments that took into account all of their social and health needs based around their strengths. Suggested areas for improvement include: for system leaders need to address issues around quality in the independent social care market with a more proactive approach to contract management and oversight; clearer signposting systems to help people find the support they need, particularly for people who funded their own care; and less reliance on paper based systems when people are discharged from hospital.
(Edited publisher abstract)
One of 20 targeted reviews of local authority areas looking at how older people move through the health and social care system, with a focus on how services work together. Specifically, it reviews how the local system is functioning within and across three areas: maintaining the wellbeing of a person in their usual place of residence, crisis management, and step down, return to usual place of residence and/ or admission to a new place of residence. The review found there was a clear shared and agreed purpose, vision and strategy described in the Happy, Healthy at Home plan, which was articulated throughout all levels of the system. Most staff were committed to the vision and agencies were also working together to keep older people safe at home rather than hospital. Reviewers also identified examples of some good joined up interagency processes, particularly the Bradford Enablement Support Team (BEST) for reablement, the MAIDT (multi-agency integrated discharge team) and The MESH team (the medicines service at home). Overall, people who lived in Bradford were supported to live in their own homes and their communities for as long as possible and received holistic assessments that took into account all of their social and health needs based around their strengths. Suggested areas for improvement include: for system leaders need to address issues around quality in the independent social care market with a more proactive approach to contract management and oversight; clearer signposting systems to help people find the support they need, particularly for people who funded their own care; and less reliance on paper based systems when people are discharged from hospital.
(Edited publisher abstract)
Subject terms:
hospital discharge, older people, integrated care, information sharing, hospital admission, prevention, emergency health services, interagency cooperation, access to services, leadership;
One of 20 targeted local system reviews, carried to look at how older people move through the health and social care system, with a focus on how services work together. The review looked at how the system was functioning across three areas: maintaining wellbeing in usual place of residence; crisis management; and step down services, return to usual place of residence and/ or admission to a new place of residence. The results found that although there was a shared vision across health and social care which described the importance of preventative support that would enable people to stay healthy for longer (articulated in the Better Care Plan), services had not always worked effectively together. It also found there was not a clear framework for partners to work together on a routine basis at operational level, with interagency working dependent on local relationships. In relation to people's experiences of services, the review found that people were able to access services in the community to prevent social isolation and that when people were referred to services through their GPs there was good support to access other services. However, people sometimes had difficulties in accessing services directly, particularly self-funders. There was also a shortage of care provision to support people at home and a risk that people could experience delays when being discharged from hospital. Suggested areas for improvement include for leaders in health and social care to work more effectively together to deliver an integrated strategy across Wiltshire and update the Better Care Plan; and that contracts with independent health and social care providers should have clear specifications and an outcome framework.
(Edited publisher abstract)
One of 20 targeted local system reviews, carried to look at how older people move through the health and social care system, with a focus on how services work together. The review looked at how the system was functioning across three areas: maintaining wellbeing in usual place of residence; crisis management; and step down services, return to usual place of residence and/ or admission to a new place of residence. The results found that although there was a shared vision across health and social care which described the importance of preventative support that would enable people to stay healthy for longer (articulated in the Better Care Plan), services had not always worked effectively together. It also found there was not a clear framework for partners to work together on a routine basis at operational level, with interagency working dependent on local relationships. In relation to people's experiences of services, the review found that people were able to access services in the community to prevent social isolation and that when people were referred to services through their GPs there was good support to access other services. However, people sometimes had difficulties in accessing services directly, particularly self-funders. There was also a shortage of care provision to support people at home and a risk that people could experience delays when being discharged from hospital. Suggested areas for improvement include for leaders in health and social care to work more effectively together to deliver an integrated strategy across Wiltshire and update the Better Care Plan; and that contracts with independent health and social care providers should have clear specifications and an outcome framework.
(Edited publisher abstract)
Subject terms:
older people, prevention, integrated care, commissioning, hospital discharge, interagency cooperation, leadership, emergency health services, hospital admission;
This report is one of 20 targeted reviews of local authority areas looking specifically at how people move through the health and social care system, with a focus on how services work together. Despite there being two separate transformation strategies across East Sussex, East Sussex Better Together (ESBT) and Connecting 4 You (C4Y), the review team found system leaders had a clear and aligned purpose and vision for providing health and social care services. There was a strong commitment and high level of trust between the system leaders, to serve local people well. Some of the key findings of the review were: preventative approaches to health and social care delivery were well thought through and embedded; there was a wide range of effective initiatives that were supporting people to remain in their own home and avoid hospital admissions; there were some good examples of shared approaches and local agreements that supported local people in having timely access to services and support that met their needs. However when older people were admitted to hospital they were often subject to delays in their discharge – this was often due to the unavailability of suitable care home beds and a lack of capacity in domiciliary care provision. All system leaders were working together to reduce delayed transfers of care and recently developed operational protocols had improved patient flow. Performance information showed the system had made improvements over recent months and the number of delayed care transfers had reduced. However there was still work to do to effectively manage and shape an affordable nursing home market and increase the availability of domiciliary care so that people’s needs were met in a timely way.
(Edited publisher abstract)
This report is one of 20 targeted reviews of local authority areas looking specifically at how people move through the health and social care system, with a focus on how services work together. Despite there being two separate transformation strategies across East Sussex, East Sussex Better Together (ESBT) and Connecting 4 You (C4Y), the review team found system leaders had a clear and aligned purpose and vision for providing health and social care services. There was a strong commitment and high level of trust between the system leaders, to serve local people well. Some of the key findings of the review were: preventative approaches to health and social care delivery were well thought through and embedded; there was a wide range of effective initiatives that were supporting people to remain in their own home and avoid hospital admissions; there were some good examples of shared approaches and local agreements that supported local people in having timely access to services and support that met their needs. However when older people were admitted to hospital they were often subject to delays in their discharge – this was often due to the unavailability of suitable care home beds and a lack of capacity in domiciliary care provision. All system leaders were working together to reduce delayed transfers of care and recently developed operational protocols had improved patient flow. Performance information showed the system had made improvements over recent months and the number of delayed care transfers had reduced. However there was still work to do to effectively manage and shape an affordable nursing home market and increase the availability of domiciliary care so that people’s needs were met in a timely way.
(Edited publisher abstract)
Subject terms:
integrated care, interagency cooperation, systems leadership, prevention, home care, older people, delayed discharge, residential care, nursing homes;
One of 20 local area reports produced as part of the local system reviews programme to understand how older people move through the health and social care system, with a focus on the how services work together. It looks at how hospitals, community health services, GP practices, care homes and homecare agencies work together. It looks at the planning, commissioning and delivery of health and social care services across three key areas: maintaining the wellbeing of a person in their usual place of residence, care and support when people experience a crisis; and step down services, return to usual place of residence and/or admission to a new place of residence. Across these three areas, the review asks whether services are: safe, effective, caring, responsive, and well led. The reviewers found that a system-wide commitment to transform and integrated services, with Trafford Council and NHS Trafford Clinical Commissioning Group sharing responsibility for a new model of integrated services due to come into effect in April 2018. However, the experience of people receiving health and social care was varied. There were missed opportunities to support people to stay in their usual place of residence and prevent admissions to hospital. In addition, although services were in place to support people as they prepared to come out of hospital, there was insufficient capacity in homecare services to meet demand.
(Edited publisher abstract)
One of 20 local area reports produced as part of the local system reviews programme to understand how older people move through the health and social care system, with a focus on the how services work together. It looks at how hospitals, community health services, GP practices, care homes and homecare agencies work together. It looks at the planning, commissioning and delivery of health and social care services across three key areas: maintaining the wellbeing of a person in their usual place of residence, care and support when people experience a crisis; and step down services, return to usual place of residence and/or admission to a new place of residence. Across these three areas, the review asks whether services are: safe, effective, caring, responsive, and well led. The reviewers found that a system-wide commitment to transform and integrated services, with Trafford Council and NHS Trafford Clinical Commissioning Group sharing responsibility for a new model of integrated services due to come into effect in April 2018. However, the experience of people receiving health and social care was varied. There were missed opportunities to support people to stay in their usual place of residence and prevent admissions to hospital. In addition, although services were in place to support people as they prepared to come out of hospital, there was insufficient capacity in homecare services to meet demand.
(Edited publisher abstract)
Subject terms:
older people, integrated care, interagency cooperation, commissioning, adult social care, health care, quality assurance, performance evaluation, prevention;