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

Quality care services are not just about more money


I recently read an article in the Times that reaffirmed my view that quality care services are not just about money. The article referred to a woman who had spent weeks looking at places for her father, who has had dementia for 12 years and now needs specialised nursing. In her search she came across the average, the diabolical and the inspirational, all within a few miles of his town.

Surprisingly, money didn’t seem to have the greatest effect on quality. The most expensive felt like a prison with the dementia inmates locked in, staff vacancies, grey sloppy food, a regimented timetable and dark, echoing corridors.

Elements of a good care home

The most impressive was the cheapest not-for-profit charity home where even the handyman stopped for a chat while putting up a curtain, there were packets of digestives on tables, the vicar popped by, the Brownies sang a song, and there were signs on each door with instructions such as: “Mrs. Jones likes her tea lukewarm, her hand shaken not squeezed and a cuddle at night”. The staff were motivated, kind and chatty. Everyone wandered freely, couples were welcomed, their bedrooms were covered in cards and photos, the garden was full of benches and bird feeders and when they demanded liver and bacon it was provided instead of pizza. But it has a long waiting list.

Difficulties facing social care services

We all know that financially it’s tough to run a care home. At least 148 businesses became insolvent in 2017, up 83 per cent on the previous year; 2,492 residents were evicted with nowhere to go because their homes closed, up 39 per cent on the previous year. This is particularly harsh for those with dementia who need familiarity. They are also often the ones being charged the highest rates. According to a report this week by the Alzheimer’s Society, providers can add as much as 40 per cent to the bill for dementia patients. About 850,000 people have dementia in Britain and pay an average of £100,000 for their end of life care. Increasingly, families cannot find anywhere that will take them, so they end up on hospital wards.

There are also not enough staff for care homes, with vacancy rates running at 11.4 per cent and 90,000 places unfilled. That’s before Brexit curbs the number of EU migrants. Caring is viewed as “unskilled labour” but the British need to see it as a vocation and a worthwhile career.

The elderly staying at home often aren’t faring any better. According to Age UK, 1.4 million older people are now not getting the necessary help to carry out essential tasks such as washing and dressing, a 20 per cent increase in only two years. There are already 7.6 million people caring for elderly relatives but even with their help the Local Government Association is warning of a £3.5 billion funding deficit by 2025.

When a care home place is not available the NHS fill the gaps. Simon Stevens, chief executive of NHS England, said recently that the equivalent of 36 hospitals were out of action because of a lack of social care.

Funding in the future

This week Matt Hancock, the new health and social care secretary, announced £240 million for the elderly, which could provide 71,000 more domestic care packages to help pensioners stay at home. This will alleviate some pressure on wards but it’s not going to address the long-term issues. Mr Hancock hasn’t been allowed to announce anything more radical, although he has been pushing quietly for a new social care fund where payments could be deducted by employers for future care costs. By the end of this parliament there will be a million more people in Britain over 75 than there were at the start of it.

Summary

We bang-on about the lack of funding for social care services, which it badly needs. But, as this lady found a cheapest not-for-profit charity home in her opinion provided the best service. Reading between the lines what she found was a home, who knew the service users and their preferences. Staff who were motivated and chatty and made everyone feel welcome. These things are not about money, they stem from the leadership of the manager, supported by staff who are committed to a culture based on the values of a quality service.

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

True cost of dementia care


A recent research report Alzheimer’s Society has uncovered the true cost that people are paying for dementia care.

The research (2017) shows the typical total cost of dementia care for one person is £100,000. For many it can be much higher. It would take someone 125 years to save that much if they put away the amount they contribute, on average, to a pension. It’s impossible to expect everyone to be prepared for these costs, and there can be devastating consequences. The Society often hears from people affected by dementia who have spent everything they have on care and have even sold their home. Others who need significant support have felt forced not to access care because of the expense.

This puts their health, and sometimes the health of those around them, at risk. ‘Some of us can’t afford basic adaptations – I couldn’t afford a bed sensor for my mother. She went missing one night and the local police force sent out two helicopters and two cars to search for her. What would’ve been more cost effective?’ People living with dementia face higher charges for care and support than those with other conditions.

Dementia can be complex and involve symptoms that need tailored support. This means care providers often charge a premium rate for dementia care. We know that in some places this is up to 40% more than the ‘standard’ price. This extra cost isn’t covered by the NHS, even funding meant to cover both health and care needs, such as NHS Continuing Healthcare, is normally out of reach for people with dementia. Instead, people who need the care to survive end up paying more. Cash-strapped councils fail to pay or are unable to cover the extra money needed to provide complex support. When councils can’t cover the full cost, people with dementia and their families are forced to pay a ‘top up’ payment. This can be hundreds of pounds a week.

The Alzheimer’s Society are adamant that no one should have to spend everything they have on care. But people living with dementia spend a disproportionate amount of their assets on the care they need. Of the £26 billion a year spent on dementia care in the UK, two thirds is shouldered by those affected. There is a strong feeling about how unbalanced the division of responsibility between individual and state currently is. People affected by dementia accept that they should make some contribution towards the cost of their care. But this should be a fair amount that does not impact on their wellbeing or ability to live a normal life.  The cost of home care for some people can cost up to £38,000 a year.

Unfair Approach to care costs

This issue is made worse by the lack of a cap on care costs. In England, the amount after which someone pays for care – assets above £23,350 – has not changed in eight years. The combination of expensive care, and no limit on what someone can spend, means some people spend nearly everything they have.

At the same time, the number of local authorities offering an increased rate to providers to reflect the extra cost of dementia support has dropped. This has meant increased demands for top-up fees from families, poor quality care from providers operating on a shoestring budget, and providers even refusing to accept people with dementia. What aggravates people most is a person with dementia who paying for expensive care sitting next to someone who is paying nothing.

The research (Alzheimer’s Society and YouGov, 2018) shows people’s strong feelings about costs. Nearly three quarters (73%) of the public think it’s unfair people with dementia face using their assets to pay for care, while those with a different condition get support through the NHS.

The researchers also found 79% of respondents believed someone could face spending everything they have on dementia care. Also, three in five people now worry that any savings they have will be spent on care and support, leaving nothing to pass on to their loved ones. This is compared to 40% before the General Election in 2017 (Alzheimer’s Society and YouGov, 2017).

Summary

This report provides further evidence of a fractured social care system that is blatantly leaning on carers to pay for services that people with dementia so desperately need. It is an indictment of central government that arguably the people who need the most expensive care are being given the least support. We rightly bang on about equality in social care services and society as a whole, but, it is hard to see why people with dementia are paying for expensive care, while some others are paying nothing. Where is the equality in that?

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

People over the age of 85 needing 24-hour care is set to double


The number of people aged 85 and over needing 24-hour care is set to double, says a new study, as an expert warns the care system is “at breaking point”.

The study, published in the Lancet Public Health journal, analysed the projected health needs of the elderly in England between 2015 and 2035.

It found that the number of 65-year-olds and over needing round-the-clock care is also set to rise by a third.

The government says adult social care reforms will be set out in the autumn.

The modelling study, carried out by Newcastle University and the London School of Economics and Political Science, highlighted the fact that the fastest growing demographic in the UK is elderly people over 85, whose numbers are projected to more than double by 2035, increasing by 1.5 million.

Many of these elderly will develop multiple long-term health conditions, such as dementia and diabetes, leading to increasingly complex care needs.

The number of over-85s requiring help throughout the day with tasks such as dressing, bathing and going to the toilet is estimated to almost double to 446,000 by 2035.

By the same time, the experts predict that a million over-65s will need similar 24-hour care.

Prof Carol Jagger, from the Newcastle University Institute for Ageing and senior author of the study, said the number of unpaid carers is in decline. She warned that relying on unpaid family carers was not sustainable and said: “The challenge is considerable.

“Our study suggests that older spouse carers are increasingly likely to be living with disabilities themselves. “On top of that, extending the retirement age of the UK population is likely to further reduce the informal carer pool, who have traditionally provided for older family members.”

Investment

Nick Forbes, senior vice-chair of the Local Government Association, warned that more investment was needed to avoid a crisis. “Adult social care services face a £3.5bn funding gap by 2025, just to maintain existing standards of care,” he said.

“The system is at breaking point, ramping up pressures on unpaid carers. “There is an urgent need to plug the immediate funding gap and find a long-term solution to how we pay for adult social care.”

The study also noted that there were increasing numbers of adults aged over 65 living independently, with a rise of 60% forecast by 2035.

However, as they got older men were more likely to remain independent, whereas women will spend almost half of their remaining life with low dependency needs and more years needing intensive 24-hour care.

The researchers categorised elderly people’s care needs as high dependency if they need round-the-clock care, medium dependency if they need help at regular times daily, or low-dependency if they require support less than daily and are generally looked after in the community.

Focus on disabling conditions

Prof Jagger said this highlighted the importance of focusing on disabling long-term conditions, such as arthritis, that were more common in women than men.

“The rise in obesity is hitting women harder than men, and men have probably benefitted more from the reductions in cardiovascular disease.

“Women also suffer from a decline in muscle mass, and so I am stressing the importance of physical activity and maintaining strength and balance.”

She added: “This expanding group will have more complex care needs that are unlikely to be met adequately without improved co-ordination between different specialties.”

The report also predicts that the number of people aged over 65 with dementia and at least two other diseases will double by 2025 and treble by 2035.

Summary

This study published in the Lancet Public Health journal highlights the challenge faced by governments regardless of their political persuasion in meeting the future care needs of people in England. The study found that the fastest growing demographic in the UK is elderly people over 85, whose numbers are projected to more than double by 2035, increasing by 1.5 million. Many of these people will develop multiple long-term health conditions such as dementia and diabetes, leading to increasingly complex care needs.

Despite government platitudes claiming additional funding has been made to the social care sector, those who work in the industry know that this level of investment is no more than a sticking plaster measure. What is needed is real investment now and, in the future, along with a strategy that addresses the complex care needs of people who are living longer. To rely on the valuable contribution made by carers is unsustainable.

Albert Cook BA, MA & Fellow Charted Quality Institute
Managing 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