A REVIEW into how health and social services are delivered in Wiltshire has shown that a lack of joined up systems and domineering council involvement has led to gaps in people’s care.

The Care Quality Commission (CQC) conducted a report into Wiltshire Council’s health and wellbeing board (HWB) as part of a series of local system reviews focusing on how older people move through the health and social care system, including how hospitals, community health services, GP practices, care homes and homecare agencies work together.

The report found a “system-wide” commitment to providing this care to people in Wiltshire, but that services “had not always worked effectively together”.

CQC inspectors “heard concerns” about the functioning of the HWB and Wiltshire Council’s management of it, reporting: “It was not perceived as a driver for change and was dominated by the local authority. It did not demonstrate effective system working. Although stakeholder partners attended the Health and Wellbeing Board meetings, they did not feel listened to. There was a joint commissioning board that met monthly but we heard that the clinical input into these meetings was not effective.

It said a “churn of leadership and a succession of interim posts” throughout the system was “compromising the shared direction and pace of change”.

The CQC found the HWB to be “well-established” but said it was “operating very much as a formal council committee”.

“There was not a clear forum for the local authority and CCG to work together and there was not a forum for providers including GPs, acute, mental health providers, social care providers and the voluntary sector to come together to shape the future delivery of integrated care,” it added.

The report praised frontline care staff, who “were committed to achieving the best outcomes for people and were genuinely caring in their approach”, but said it had seen “some frustration” that they could not always function in an integrated way.

And it said some people had difficulties in accessing services, particularly those who funded their own care.

“People often had to tell their stories many times as different professionals required different assessments, rather than using a single assessment approach,” it added.

The CQC also said there was a risk of people experiencing delays when being discharged from hospital and people at the end of their lives were not prioritised in terms of receiving a package of care.

Chief Inspector Steve Field said “although there are some high quality services available” and a clear intention to improve the overall service, “the reality for people using services is inconsistent”.

“Some older people are having a less than satisfactory experience as they move across health and social care,” he added.