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 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

NHS Digital innovation £1m up for grabs for adult social care technology pilots


It was good to hear that Local authority projects that use digital innovation to help benefit people who access adult social care can bid for share of £1 million in funding.

The funding, provided by NHS Digital and managed by the Local Government Association (LGA), with support from the Association of Directors of Adult Social Care (ADASS), will be awarded to local authorities that put forward projects that support forward-thinking uses of digital technology in the design and delivery of adult social care.

Twelve will receive £20,000 to design a digital solution to address a specific issue with their service, with six receiving up to a further £80,000 to support its implementation.

Those bidding will need to focus on one of three themes:

  • efficiency and strengths-based approaches;
  • managing marketing and commission; and
  • sustainable and integrated social care and health systems.

Formerly known as the Local Investment Programme, the Social Care Digital Innovation Programme aims to encourage the adult social care sector to make better use of technology.

This new initiative builds upon support for the strategy advocated by the CQC who for some time have been encouraging providers to make more use of technology in the provision of care services.

James Palmer, programme lead for the social care programme at NHS Digital said: “Last year’s projects delivered inventive, forward thinking and creative solutions to local challenges in social care. They have led to successful outcomes for both services and the people who use them.

“This year, the funding will help to identify and address some key pinch points within local authority services, especially those around the integration of health and social care systems. We are looking forward to seeing the innovative solutions that councils come up with in response to our latest round of funding.”

Previous projects to have received support include home video-conferencing in Essex, voice-activated home support in Hampshire and electronic referrals for home care packages in Hampshire and electronic referrals for home care packages in Sefton and Knowsley.

Sefton and Knowsley Mayor Kate Allsop, deputy chair of the LGA’s Community and Wellbeing Board said: “We are committed to enhancing the role that information and technology can play in the commissioning and delivery of health and social care services.

“As part of this agenda we are pleased to run another funding round in collaboration with NHS Digital, to stimulate digital solutions to social care challenges at a local level.”

The closing date for applications is 4pm on 1 June.

An NHS Digital-commissioned review of the state of IT in social care revealed a myriad of challenges.

This latest initiative by NHS Digital is just one of many such funding approaches with the aim of increasing the use of technology in social care. There is little doubt that the funding crises that is affecting social care, has prevented investment in the use of technology. Many providers ae aware of the benefits that technology can bring to adult social care services but where is the money coming from to pay for it?

Those who work in the social care industry are full aware that the use of technology will play an increasingly important role in the future provision of adult social care services. We can also expect it to be included in the Governments Green Paper on the future of social care services to be published in the summer.

Summary

The offer of more funding from NHS Digital to fund specific technology projects should be welcomed. But this piecemeal approach is only scratching the surface when it comes to the technology needs of adult social care services.  What is needed is a government funded worked-out strategy for the implementation and use of technology that is available to all providers and commissioners.

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

A strategy for improving recruitment and retention of staff in social care services


The difficulties faced by providers in attempting to recruit staff for social care services continues to present significant challenges. Low wages, conditions of service and lack of career opportunities are often cited as major reasons why it has become increasingly more difficult to attract people to work in social care.

In December last year, Health Education England published Facing the Facts, Shaping the Future: A Health and Care Workforce Strategy for England to 2027.

  • The adult social care workforce is larger than the NHS workforce but has lower average pay, fewer qualifications and more part time staff.
  • Turnover is high and there are 88,000 vacancies.
  • Required growth of between 14% and 31% is forecast by 2030.
  • 18% of the workforce is from overseas with regional variation.
  • 20,300 independent organisations provide care in England.
  • The government is consulting on changing aspects of the system.

The report highlights that the majority of the care workforce is likely to earn at or near the National Minimum Wage. The workforce is 82% female with an average age of 43 and nearly half work part time including 54% of care workers. Zero-hour contracts cover 24% of all staff and 33% of care workers. Turnover is high at over 25% with around 347,000 staff leaving roles during 2016/17, 33% of those leaving the sector altogether.

The sector faces recruitment and retention challenges at all levels, in both regulated and unregulated professions. Vacancy rates are higher than the general economy at 6.6% compared to 2.5%, with approximately 88,000 vacancies. Workforce diversity, as with the NHS, means a combination of interventions are needed to support an adult social care workforce for the future. The government has recognised pressures on the social care system with an additional £2bn, however a number of factors such as pay, large numbers of small employers, contract status and retention and recruitment make workforce issues challenging for the sector.

Increasing demand for adult social care

Demand is growing as people live longer with more comorbidities leading to more complex health and care needs. According to “Horizon 2035: health and care workforce futures”, by 2025 unconstrained demand for lower skilled direct care staff is likely to increase by 12%, (around 120,000 more jobs), and an overall workforce demand increase of 14% (190,000 jobs). Skills for Care suggest that need might be as much as a 31% increase or 500,000 jobs by 2030. Factoring in vacancies approaching 90,000 and the challenge of the current staffing model to meet these demand projections is clear. It also has implications for the wider economy, with labour used to meet this increase not being available to other sectors. There are interventions that can alleviate some of this increasing demand whilst meeting peoples’ desire to remain independent and well at home for longer. These include social care staff supporting prevention and public health interventions; better join up between health and care; more support for carers; and new technology.

Maximising recruitment

There are two focus areas for ASC recruitment. The first is training and skills development. Roles tend to have low entry requirements with around half the workforce having no formal social care qualifications. This is especially true of the vast majority of staff providing direct care and support. The regulated professions tend to perform more supervisory roles. There are no standard training requirements across large parts of the sector with too many staff not receiving training or professional development, despite providing direct care for vulnerable adults whose dignity and quality of life is dependent on the quality of their work. The Care Certificate, developed by HEE, Skills for Care and Skills for Health, provides a standard induction framework across social care and health. There is no mandated skills training or development across employers.

The second recruitment challenge is overseas staff. UK nationals make up 83% of the ASC workforce; 7% (around 90,000), are non-UK EEA nationals and 11% (about 140,000) are from the rest of the world. Direct care staff form the biggest group of EEA staff with about 67,000 workers

The majority of roles have low entry requirements and limited career structures. The 20,300 employers separately determine job titles and structures, which makes demonstrating career pathways challenging meaning staff often seek career progression by leaving the sector. Increases in the National Living Wage have driven up pay for those on the lowest wages but also narrowed pay differentials thereby reducing the attractiveness of seeking promotion or progression in some cases.

Summary

The Health and Care Workforce Strategy for England to 2027 has involved consultations with those who have a vested interest across the care industry and was due to be completed last month. Any new strategy will need to take into account that if we are to recruit and retain more staff, we cannot continue to have over 20000 care providers determining staff job titles and career structures. We need a national set of employment conditions that give staff encouragement to seek career progression with available training, that is recognised and financially rewarded.

If staff can be supported to gain satisfaction in their work through training that leads to improvement of skills, career opportunities and financial rewards, then we have the basis for a thriving, consistent and high-quality workforce. We may then begin to see an improvement in recruitment and retention of staff in the social care industry.

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