A health economy designated as one of the government’s integration pioneers has been warned its poor relationships with social care are putting patients at risk, HSJ has learned.

The NHS emergency care intensive support team was called into Cornwall after persistently poor performance against the four hour accident and emergency standard at Royal Cornwall Hospitals Trust.

Between June and September just 72.4 per cent of patients attending its main emergency department were admitted or treated and discharged within four hours, against a target of 95 per cent. The trust has not achieved this target since the end of 2012.

After spending a week in the area visiting the trust, community facilities and primary care during September, the support team concluded the system was fragmented, with teams from the trust, community provider Peninsula Community Healthcare and adult social care working in silos.

HSJ understands the team concluded that unhelpful relationships were one of the biggest barriers to improving A&E performance.

NHS England and the NHS Trust Development Authority have recently started working with the trust and Kernow Clinical Commissioning Group, in line with the move for more coordinated working between the national bodies.

In recent weeks performance has begun to improve, nudging above 85 per cent for the first time in months.

Speaking on behalf of all partners, Kernow CCG’s managing director Joy Youart said: “Our vision to create a truly integrated health and care service is the number one priority of all chief executives from health and local government.

“The draft report is a constructive assessment of the operational challenges and priorities for the whole system.

“All partners have pledged to get the system back on track and chief officers are meeting weekly and are working together to lead the necessary changes.”

The area was designated an integration pioneer in 2013 after impressing the Department of Health with its Living Well project.

This work was also highlighted in the NHS Five Year Forward View, published by the national bodies last month.

A pilot of the project with 100 patients in Newquay was found to have reduced emergency admissions by 30 per cent.

It is currently being rolled out to a further 2,000 patients in Penwith and east Cornwall.