What do we see when you look up at the night sky? Stars of course. Even if we can’t name them, we can to pick out the brighter ones, spot occasional falling stars, perhaps distinguish stars from planets. Some observers, however, see not just stars, but constellations. They make links between individuals’ brightnesses which the rest of us hadn’t noticed, observe changes in their relationships over time, know how one star’s light impacts upon others. Such insights give the heavens a wholly new dimension.
The Care Quality Commission has recently started to contemplate a similarly extended reality. During the spring it published reports looking at what it rather pedestrianly describes as Quality in a Place, first in North Lincolnshire and then in Salford and Tameside. The objective is to explore whether an overview of the services in a geographical area, as opposed to simply inspecting individual providers, can – to coin a phrase – “drive improvement”.
This approach accords of course with the actual experience of service users. A vulnerable older person almost certainly has a GP, has on occasions to go to hospital, either as an outpatient or for longer treatment, and may well need community and domiciliary care, perhaps even at some point a place in a home. Each of the agencies may separately do a pretty good job, but what does the experience as a whole feel like?
For these area studies CQC reviewed currently available data from diverse external sources, revisited its own inspection reports, held focus groups with inspectors, voluntary sector representatives and providers, and interviewed a range of senior health and care stakeholders. In Salford there was in addition an experiment in case tracking, a process which specifically examines individuals’ movement between services. Just surveying this amount of information illustrates the scale of the task.
Numerous organisations play a part in optimising people’s health and welfare, and some such as third sector bodies and independent sector providers complain that they are missing out, while the big partners – the Health and Welfare Boards, Clinical Commissioning Groups, Foundation Trusts and Local Authorities – steam ahead. Nor is co-terminosity universal. How wide anyway does one draw the net? Public attitudes are critical to people with dementia, so are schools and churches also to be embraced? As the number of units included increases, the complexity of their linkages grows exponentially.
CQC has no intention (yet?) to grade areas by their achievement in collaboration, but it does make comparisons to national averages. Some of the data it uses such as life expectancy figures, however, draw on elements way outside the scope of health and care management. Perhaps North Lincolnshire people breath easier because Skegness is bracing, certainly compared with the notorious muggy air of Greater Manchester.
Collaboration is big business, and already it is generating a bureaucracy of its own. The North Lincolnshire report contains a chart illustrating the relationships between eleven “key boards” each of course with its own regular agendas, minutes and supporting papers. Everyone signs up to the need for “an agreed vision”, but most are still struggling to achieve “a common language”.
Nor can it be assumed that all motives are pure; politicians, and even managers, are often after each other’s jobs; that’s life. In one area indeed it is openly admitted that there is an “absence of collective agreement on who leads on the integration agenda”.
CQC’s attempt to ensure that in inspecting individual trees it also captures a view of the wood they constitute is ambitious and praiseworthy, but it must be wary – to mangle more metaphors – of biting off more than it can chew.