CQC is driving social care services to make more use of technology


According to CQC technology is changing the way people provide care and treatment. It suggests that there are huge benefits to be gained for people who use services, families, carers and providers. But it’s important technology and innovation never come at the expense of high-quality, person-centred care.

Benefits of technology in care

Technology can:

  • give people more control over their health, safety and wellbeing
  • support them to be more independent or feel less isolated
  • link them to services which are important for them
  • enhance the care or treatment providers offer
  • help them communicate with families, professionals and staff
  • help staff to prioritise and focus their attention on people who need it most
  • capture and compare data and share good practice with peers.

If providers are to make the best use of technology then people’s safety, dignity and consent must be at the centre of decisions about their care. This applies to decisions about the use of new technology. Being clear about people’s rights, privacy and choice must always come first.

Questions to ask before using technology

CQC ask providers to consider the following question if they are thinking about using technology to deliver care.

  • How will you involve people who use your service in your plans and putting the new technology into use?
  • What do the people it will affect need to know to make an informed choice? Do they fully understand the implications of the new technology?
  • Who will the technology affect and how will it affect them?
  • What outcome do you want to achieve? How will you measure it?
  • Will the technology fully meet the needs of the people using your service? If not, what else do you need to provide?
  • Are there more appropriate ways to meet these needs?
  • What are the practical and legal issues you need to think about before you introduce new technology?
  • What are the risks and how will you manage them? Particularly during transition and early implementation of the technology or system. What is your contingency plan to keep people safe?
  • How have you involved your staff? What information and training do they need so they can be confident and competent? This includes understanding their responsibilities and         how to respond to associated risks.

Innovative use of technology can help answer our five key questions

When CQC inspect and monitor health and social care services, there are five key questions they ask. The following examples illustrate how technology can support good and outstanding person-centred care.

Safe

Helping ensure key information is accurate and easy to share with caring professionals in real time

Effective

Supporting effective communication and more efficient use of resources, including finances

Caring

Supporting person-centred care and helping staff to spend more time on the things that really matter

Responsive to people’s needs

Supporting providers to be more proactive and responsive to changing needs by helping to identify developing risks or needs more quickly

Well-led

Supporting more effective quality assurance through more effective communication, information sharing and improved data analysis.

Bettal Quality Consultancy

Here at Bettal we have recognised the contribution that technology can make to high quality social care services. We have developed a digital audit tool to measure a services performance against the key Lines of Enquiry. Next year we will be launching our new digital person centred plan and digital risk assessment tool.

For further information on Bettal products please visit our Care Service Products section.

Summary

CQC have recognised that technology has an important part to play in social care services. We are only at the beginning of a journey that will see far greater use of technology in the future. The benefits to service users and staff are there for all to see, and I have no doubt that in time you will see less time spent with onsite inspection. The creation of digital routs which will allow inspectors to measure social care services performance off site. This will lead to a further reduction in the number of inspectors.

However, it still needs to be repeated that technology should not be viewed as a substitute for staff time spent with service users, but rather a supportive mechanism that allows more time to be spent with them.

Albert Cook BA, MA & Fellow Charted Quality Institute
Managing Director
Bettal Quality Consultancy

New Skills for Care advice on safe staffing


Skills for Care as part of their ‘Good and Outstanding Range’ have produced guidance for managers on safe staffing. The guide explains what the CQC looks for in terms of safe staffing and how a service can meet the regulation requirement. It includes guidance around deciding and maintaining safe staffing levels, safe recruitment practices and how to ensure staff are safe and competent.

It draws on evidence from over 60 CQC inspection reports and case studies from residential and community-based services who are rated ‘good’ and ‘outstanding,’ to help providers to understand what ‘good’ looks like and learn from best practice.

What is safe staffing

According to the guide safe staffing is about having enough staff, who have the right values and skills, to deliver high quality care and support. It involves:

  • having safe staffing levels, including putting contingency plans in place;
  • recruiting the right people, with the right values, skills and experience to deliver safe care and support;
  • doing the right recruitment checks;
  • ensuring staff are competent and safe to do their role.

Safe staffing is not just about numbers it about having experienced and competent staff who have a clear understanding of the requirements of service users care plans, who stay with the service long enough to establish meaningful relationships with those who they care for.

Identifying characteristics of services who have inadequate staffing

There are some common characteristics of services who have inadequate staffing. If some, or all, of these apply to your service this could indicate that a service is not meeting the requirements for safe staffing.

  • High turnover of staff;
  • Struggle to recruit enough staff;
  • New staff leave within a short time of joining;
  • High sickness rates that are particularly stress related;
  • Unorganised rota system and processes that are difficult to use and review;
  • Rota’s are constantly changing;
  • Staff only have time to perform duties and tasks with no time to ‘care’;
  • Staff don’t have time to communicate with
    people they support, families and professionals;
  • Little consistency in staff;
  • Over-reliance on temporary workers;
  • Staff inductions are limited and/or rushed;
  • Staff learning, and development is restricted to mandatory training;
  • Limited support for staff such as supervisions.

Impact on service users

  • staff have no time to respond to calls for help;
  • there is not enough time to do an effective handover;
  • staff support people to get ready and have meals at a time that best suits them rather than the individual;
  • not enough staff to support people at meal times;
  • medication documentation is rushed.

CQC checks on safe staffing

CQC will require managers to demonstrate how they arrived at the numbers of staff to ensure service users are safe. Dependency tools can help the manager to decide how many staff will be needed. They can be used to collate information about the needs (or dependency) of people who need care and support, how many hours/staff support will be needed, and enable the manager to log other requirements such as time for administration, record keeping and communicating. This can help to make informed decisions about how many staff will be needed in your service to meet safe staffing levels. In addition, it provides evidence of how you arrived at your decision about the numbers of staff.

When using a dependency tool, the manager must ensure staff are competent to use it and use it consistently. If they don’t, this can have a negative impact on the outcome of a services inspection.

One residential home graded inadequate by CQC, found that having checked the records following the use of the dependency tool, that records of the assessment hadn’t been completed for some weeks. The provider was unable to demonstrate on what basis they’d decided the current staffing numbers per shift against the needs of people.

Summary

This latest guide by Skills for Care on safe staffing gives providers useful advice on how to ensure CQC requirements can be met. It helps providers to recognise the characteristics of services who have safe staffing issues. Dependency tools can be useful in providing evidence of how managers decided on staffing levels, but they should only be used by competent and experienced staff capable of keeping records up to date. Managers are strongly advised to obtain the guide on safe staffing by visiting the Skills for Care Website.

Albert Cook BA, MA & Fellow Charted Quality Institute
Managing Director
Bettal Quality Consultancy

CQC receives award to encourage innovation


Through its Regulators’ Pioneer Fund, the Department for Business, Energy and Industrial Strategy (BEIS) has awarded the CQC £500,000 to explore how it can work with providers to encourage good models of innovation.

CQC says this draws on our long-standing commitment to co-production and learning from providers, while upholding people’s right to safe, high-quality care.

The Regulators’ Pioneer Fund was established by the Government to fund unique projects that will help regulators support the development of new products and services. These projects are aligned with particular “Grand Challenges” set out in BEIS’ Industrial Strategy and aim to unlock the potential of innovation to help tackle these issues.

The CQC project being backed will allow the organization to investigate and test new ways of engaging with innovative providers to meet the needs of an ageing population, while making sure that patient safety is kept at the heart of developing services. This could include ‘regulatory sandboxing’, where implementation of technology can be tested against the regulations in a controlled way, to ensure that regulation achieves the best outcome for people using services.

Commenting on the announcement of the award, Ian Trenholm, Chief Executive, said: “We have always been committed to developing our approach to regulation alongside providers”. As technology is becoming an integral part of the way care is delivered we need to make sure our approach supports innovative new services.

Just as people’s needs and expectations of care are changing, so are the innovative ways that providers can support them. Regulation has to keep pace with and encourage progress – whilst also making sure that people receive the safe, high-quality care that they deserve, regardless of how it is delivered.

“This funding from the Regulators’ Pioneer Fund will help us work with and encourage innovative providers at this exciting time, helping regulation to develop effectively and, encouraging technological change.”

In announcing the fifteen winning bidders for the £10m Regulators’ Pioneer Fund, Business Secretary Greg Clark said:

“The UK’s regulatory environment is recognised as being among the best in the world and through our modern Industrial Strategy we are building a business environment in which Britain’s dreamers, developers and disruptors can continue to thrive.

“These projects will further strengthen our regulatory system and ensure that it keeps pace with the innovation and technological advances needed to power our economy now and in the future.”

Embracing technology to bring about change

This award gives an insight in how the CQC sees the future of social care services. There is little doubt that they wish to see more providers making use of the new technology that is constantly becoming available. Providers will be encouraged to make more use of technology, and even if I dare say it, in the not too distant future standards will be introduced to measure the provider’s use of technology.

In my experience at one end of the scale it is the larger providers with sufficient profit margins that are able to afford the investment required. While at the other end we have smaller providers, who struggle to make ends meet to keep their services running let alone invest in technology. The number of care home closures in the past year gives us evidence of the struggle.

Summary

This award to the CQC through its Regulators’ Pioneer Fund should be welcomed. Social care services need innovation and providers should embrace technology that can improve their services. However, CQC should take care that they do not drive the smaller provider out of the care industry, because they cannot keep pace, let alone afford new technology.

I am prepared to accept that technology has an integral part to play in the delivery of social care services, but it must be accompanied by staff and Services Users who are able to make the best use of it. We should be wary that we do not take our eye off the ball. Placing too much focus on what technology can offer us at the cost of spending less time on providing a face to face service for Service Users.

Albert Cook BA, MA & Fellow Charted Quality Institute
Managing Director
Bettal Quality Consultancy

The CQC has called for an overhaul of health and social care funding, commissioning and regulation


A recent article published in Care Home professional draws attention to The Beyond Barriers report. This follows the completion of 20 local authority area reviews exploring how older people move between health and social care services in England.

Sir David Behan, Chief Executive of CQC, said: “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.”

The report makes a number of recommendations including long-term funding reform in order to help social care and NHS commissioners pool their resources to meet the needs of their local populations.

Care Minister Caroline Dinenage said: “This report confirms what we already know – the provision of NHS services and social care are two sides of the same coin and it is not possible to have a plan for the NHS without having a plan for social care.

“There are good examples of progress in integrating health and care, including through the Better Care Fund and ongoing joint health and social care assessments pilots, but we know we need to do more. That’s why we will publish a Green Paper in the autumn on social care around the same time as the government’s long term plan for the NHS.”

The report’s findings were welcomed by social care leaders.

Vic Rayner, Executive Director of NCF, said: “The report highlights the real impact of the current shortfalls in integrated practice on people. By exploring the failings of the current system through the lens of people’s journeys, it makes it crystal clear why the need to change is imperative and through the exemplification of good practice – what real impact different approaches can have.”

Professor Martin Green OBE, Chief Executive of Care England, added: “This new approach is to be welcomed particularly the recommendation for better oversight of local systems and commissioning.  New regulation we hope will allow CQC to regulate not just individual organisations, but the quality of service for people across systems.

“Improving regulation is a huge part of the jigsaw, but will not be complete without commensurate funding to plug the shortfall in adult social care.”

In conclusion, key professionals in the regulation of care services including the Chief Executive of CQC are calling for urgent change in an antiquated system designed 70 years ago.

The government may wish to regulate further in the improvement of services which has been welcomed, but providers are strongly urging greater levels of funding to plug the shortfall in adult social care.

There is no short term fix to this issue, the government need to develop a long term care funding reform strategy to help better allocate resources to social and health care service.

The Care Quality Commission are hoping that new regulation will allow CQC to regulate not just individual organizations, but the quality of service for people across systems.

Stuart Cook
Director
Bettal Quality Consultancy

CQC Driving Improvement Report


This month CQC published its Driving Improvement Report. The report sets out how services who had previously been graded as inadequate improved to achieve a good grading.

Andrea Sutcliffe Chief Inspector of the CQC has stated that their work is guided by a simple principle – is this a service I would be happy for my Mum or anyone I love to use? If it is, that’s fantastic; but if it’s not good enough for my Mum, it’s not good enough for anyone’s Mum and we’ve got to do something about it.

Lots of services have taken up that challenge and improved. We wanted to share some of their experiences to help others to improve too. In the Driving Improvement Report a number of different services were approached who had been given an inadequate grading by CQC.

For each service interviewed a range of people, including people who use services and their families, registered managers, providers and owners, care staff, administrative and other staff, commissioners and social workers. CQC staff used the following questions to interview providers and managers, and adapted them when interviewing people who use services, staff and others:

  • What was your reaction to the service being rated as inadequate?
  • How did you approach improvement?
  • What support did you ask for and what support did you receive?
  • What were the obstacles to improvement? How did you overcome them?
  • Did the inspection report help you improve your service and outcomes for people?
  • How did you involve staff and support them further in their work?
  • How did you involve people, their families and carers and volunteers, who use the service?
  • How did you involve and work with local partners?
  • Could you give us some examples of tangible improvements?
  • Could you give us some examples of improved outcomes for people?
  • Looking back on the improvement journey, what have you learned, and is there anything you would do differently?
  • What are you doing to ensure improvements are sustainable? What’s next on your improvement journey?
  • To summarise, what would you say are the top five actions you took that helped your service improve?

Key Themes

Reaction to the initial inspection report

Most providers, and not just in the adult social care sector, react to a report highlighting failures with shock, surprise and disappointment. But usually when people stand back and have time to reflect, they understand the failings. As one care worker told us: “In the report we recognised the failings and could see the truth in what was said.” For committed staff the report can come as a relief, as in some of our case studies staff were struggling – doing their very best but unable to deliver the care they wanted to. Several case studies highlight the impact that a rating of inadequate and report of poor practice can have on a service’s reputation.

Leadership

The value of a good leader cannot be underestimated. In most of the providers we spoke to, a new manager had come into the service to deliver the improvements. They engage with staff, people who use services and their families; they are open to suggestions but set parameters and take tough decisions where necessary. Staff and family members in some of our featured providers commented about a manager’s door always being open.

Cultural change

Leadership and culture go hand in hand. It’s the leader’s job to shape the culture of an organisation. Failing organisations tend to have cultures in which staff are afraid to speak out, don’t feel they have a voice and are not listened to. Involving staff is one of the best ways to drive improvement.

Person-centred care

Typically, when a new manager took up the reins, they wanted to see care plans. And in most cases, these were lacking in detail and did not demonstrate that the care being provided was person-centred. It is simply not possible to provide good care if the care staff do not understand the needs of the person being cared for.

Staffing

A range of issues to do with staffing contributed to the low rating in most of the providers featured in this publication. Too many providers were struggling along without having enough staff to deliver safe and effective services. It wasn’t generally because the staff didn’t care; it was because they didn’t have the time to care as well as they should. And that put a great deal of stress on staff as well as putting people who used services at risk.

Working with partners

Most of the services we feature received support to help them improve – mainly from the corporate provider, if there was one, or commissioning bodies. The starting point was having a manager and staff who were willing to ask for support, were honest about the issues they faced, and were open and transparent about their plans for improvement.

Building a community

Providers that are good and aspire to be outstanding look beyond their own walls and seek to be part of the local community. We saw great examples of providers opening their doors to local groups, working with local schools and bringing the families of the people who use their services.

Summary

The CQC Driving Improvement Report raises a number of interesting questions regarding inadequate social care. Most managers of care services will now be fully aware of the key themes identified in this report which constantly appear in literature produced by CQC. This does not demean their importance. It would appear however, there are still too many providers graded inadequate who have still not taken on board their importance.

The services who took part in this study must have been committed to improvement when approached by CQC, otherwise they would not have agreed to it. The elements of good practice identified in this report can be followed by all providers with the same level of commitment.

Albert Cook BA, MA & Fellow Charted Quality Institute
Managing Director
Bettal Quality Consultancy