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Urgent transformational change needed at Berkshire West health system, peer review finds

Healthcare is in urgent need of change in Berkshire West.

That's the conclusion of a peer review into the district's health sector – and it says it is "deeply concerned for staff across the system".

Urgent transformational change is needed at Berkshire West health system
Urgent transformational change is needed at Berkshire West health system

The damning report lists a catalogue of defensiveness, poor communication and bad partnership relationships across the health system which are affecting care given to the population.

Things are so bad that the review team says the very visible issues in Berkshire West need resolving for staff, the local population, and the ICS, and this will need senior executive health and social care oversight and commitment, to ensure the transformational change required is driven forward.

Across the review sessions with the Berkshire West system, the peer team saw a focus on process over practice, from both health and social care perspectives.

“The challenges between health and social care organisations in Berkshire West are very visible to partner organisations, which have serious concerns for the individuals at the centre of these," it said.

“Instead of taking a ‘how can I help you’ approach, there is a ‘how can I not be landed with you’ approach."

The Berkshire West integrated care system includes Berkshire West Clinical Commissioning Group (CCG), the acute Royal Berkshire Hospital and Berkshire Healthcare foundation trusts and providers of GP services in four locality or neighbourhood ‘alliances’.

The system covers a registered population of approximately 528,000 residents in Reading, West Berkshire and Wokingham.

Through what is known as the Berkshire West 10 Integration Programme, the system works closely with South Central Ambulance Service Foundation Trust and the three local authorities in the area: West Berkshire Council, Wokingham Borough Council and Reading Borough Council.

The review is set against the current context of the Health and Care Act 2022, including the change in leadership structures with the development of integrated care systems (ICSs).

Berkshire West now sits with Buckinghamshire and Oxfordshire and is known as the BOB ICS.

“The opening presentations on day one made it clear that there were serious challenges to partnership working between the leadership from health and social care – and this was present throughout the two days of the peer review, with this culture pervading to the more junior workforce,” said the peer review report to West Berkshire Council’s health scrutiny committee.

“The peer team spoke to partner organisations which were impacted by this lack of collaborative working and heard their concern for those individuals and their loved ones trying to navigate the CHC process in Berkshire West at the most vulnerable time in their lives.”

The team heard staff found it difficult to reflect on practice in a constructive and developmental way, assuming a defensive position when professional challenge is offered. Rather than holding each other accountable for providing the best care for their people, the reflex is to "defend their own colleagues and organisation because of the history of poor relationships".

It went on to say there were examples of very poor communication, a lack of trust and collaboration between organisations and a defensiveness on the part of both health and social care colleagues.

“The difficulties arising from poor relationships between health and social care providers frustrate the potential for a joint vision for CHC in Berkshire West," it added. "Colleagues presented a story of frustration at the past and present ways of working, but no ambition for the future, and no plans about how to improve the CHC journey for those coming through in future.”

The peer team was very concerned to hear about the people at the centre of unresolved disputed cases – some of which have been ongoing for up to four years. The uncertainty surrounding these will have a detrimental impact on the quality of care being offered to those people and raises serious concerns.

“We heard of significant communication issues between health and social care and an inability for colleagues to identify their counterparts in the other organisations," it said. "We would urge any transformation work to ensure adequate time and attention is given to developing and restoring the very difficult relationships in a supportive way, recognising how hard it has been for all staff to work in CHC in this place over recent years.”

NHS England has commissioned the Local Government Association to deliver a short series of peer reviews of continuing healthcare (CHC) services. The peer review was delivered by an experienced team of peers drawn from senior leaders in health and care.

The review also covered Oxfordshire and Buckinghamshire, where the review team found "excellent" working practices and partnerships from which Berkshire West might learn.

The report goes before the health scrutiny committee next Thursday.

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