New approaches to funding commissioning and regulation needed to meet people’s health and care needs

Today we have published a report, ‘Beyond Barriers’, bringing together key findings and recommendations for change, following the completion of twenty local authority area reviews exploring how older people move between health and adult social care services in England.

Many older people have complex needs, and meeting these needs usually requires more than one professional and more than one agency to work together. CQC’s local system reviews provide a detailed insight into the journey through health and social care for people who use services, their families and carers – and identify where there are gaps which mean that people experience fragmented or poor care.

Our report highlights some examples of health and care organisations working well together – and of individuals working across organisations to provide high quality care. But the reviews also found too much ineffective co-ordination of health and care services, leading to fragmented care. This was reinforced by funding, commissioning, performance management and regulation that encouraged organisations to focus on individual performance rather than on positive outcomes for people.

The lack of a shared plan or vision resulted in people not receiving the right care in the right place at the right time – with consequences ranging from care being provided at greater expense than necessary, to increased pressure on services, to people’s quality of life being significantly diminished.

Our findings show the urgent necessity for real change. A system designed in 1948 can no longer effectively meet the complex needs of increasing numbers of older people in 2018. People’s conditions have evolved – and that means the way the system works together has got to change too.

We have seen the positive outcomes that can be achieved when those working in local health and care organisations have a clear, agreed and shared vision together with strong leadership and collaborative relationships, and we met some outstanding professionals, working across organisational boundaries to provide high quality care. However, their efforts were often despite the conditions in place to facilitate joint working, rather than because of them. We need incentives that drive local leaders to work together, rather than push them apart.

The report sets out a number of recommendations designed to encourage improvement in the way agencies and professionals work to support older people to stay well, including:

  • Local leaders must create an agreed joint plan for how older people are to be supported in their own homes, helped in an emergency, and then enabled to return home safely. This plan must maximise the potential contribution from voluntary, community and social enterprise organisations.


  • There should be a single, joint, nationally agreed framework for measuring the performance of how organisations collectively deliver improved outcomes for older people. This would operate alongside oversight of individual provider organisations and use metrics that reflect outcomes for people – including primary, community, social care and independent care providers – rather than relying primarily on information collected by acute hospitals.


  • Local leaders should agree joint workforce plans, with more flexible and collaborative approaches to staff skills and career paths. These plans should reflect and work in tandem with Health Education England and Department of Health and Social Care workforce strategies, anticipated later this year.


  • To support the improved planning and reformed commissioning at a local level, there needs to be new legislation to allow CQC to regulate local systems and hold them to account for how people and organisations work together to support people to stay well.


  • Regulators, including CQC, should work to agree a set of performance metrics and indicators for system performance that are used to inform all regulatory activity and oversight.


As the NHS approaches its 70th birthday, genuinely person-centred co-ordinated health and care cannot just be a long-term ambition – it is an urgent and immediate requirement for meeting the changing health and care needs of people living longer with an increase in complex conditions. The NHS and social care are two halves of a whole, providing support for the same people and there must be a shared vision and performance measures at a local and national level that recognise this.

If you have any queries about this report, please do not hesitate to get in touch.

Yours sincerely,

Sir David Behan CBE

Chief Executive