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

Communicating with someone with dementia


The Alzheimer’s Society have published some useful tips on communicating with people with dementia, which may be useful to staff in adult social care services.

Before you speak

  • Make sure you’re in a good place to talk – quiet, with good lighting and without too many distractions (e.g. no radio or TV on in the background).
  • Get the person’s full attention before you start.
  • Position yourself where the person can see you as clearly as possible (eg with your face well-lit) and try to be on the same level as the person, rather than standing over them.
  • Sit close to the person (although not so close you are in their personal space) and make eye contact.
  • Make sure your body language is open and relaxed.
  • Have enough time to spend with the person. If you feel rushed or stressed, take some time to calm down.
  • Think about what you are going to talk about. It may be useful to have an idea for a particular topic ready. You can also use the person’s environment to stimulate topics.
  • If there is a time of day where the person will be more able to communicate (eg in the morning) try to use this time to ask any questions or talk about anything you need to. Make the most of ‘good’ days and find ways to adapt on ‘bad’ ones.
  • Make sure any of the person’s other needs are met before you start (eg they’re not hungry or in pain).

How to speak

  • Speak clearly and calmly.
  • Speak at a slightly slower pace, and allow time between sentences for the person to process the information and respond. This might seem like an uncomfortable pause to you, but it is important for helping the person to communicate.
  • Avoid speaking sharply or raising your voice.
  • Use short, simple sentences.
  • Try to communicate with the person in a conversational way, not question after question (it can feel like an interrogation).
  • Don’t talk about the person as if they are not there or talk to them as you would to a young child – be patient and have respect for them.
  • Try to laugh together about misunderstandings and mistakes – it can help. Humour can help to bring you closer together, and may relieve the pressure. However, be sensitive to the person and don’t laugh at them.
  • Include the person in conversations with others. This may be easier if you adapt what you say slightly. Being included can help a person with dementia to keep their sense of identity and feel they are valued. It can also help to reduce feelings of exclusion and isolation.

What to say

  • Try to avoid asking too many questions, or complicated questions. People with dementia can become frustrated or withdrawn if they can’t find the answer.
  • Try to stick to one idea at a time. Giving someone, a choice is important, but too many options can be confusing and frustrating.
  • If the person is finding it hard to understand, consider breaking down what you’re saying into smaller chunks so that it is more manageable.
  • Ask questions one at a time, and phrase them in a way that allows for a ‘yes’ or ‘no’ answer (eg rather than asking someone what they would like to do, ask if they would like to go for a walk) or in a way that gives the person a choice (eg ‘would you like tea or coffee?’).
  • Rephrase rather than repeat, if the person doesn’t understand what you’re saying. Use non-verbal communication to help (eg pointing at a picture of someone you are talking about).
  • If the person becomes tired easily, it may be better to opt for short, regular conversations. As dementia progresses, the person may become confused about what is true and not true. If the person says something you know is not true, try to find ways of steering the conversation around the subject and look for the meaning behind what they are saying, rather than contradicting them directly. For example, if they are saying they need to go to work is it because they want to feel useful, or find a way of being involved and contributing? Could it be that they are not stimulated enough?

Listening

  • Listen carefully to what the person is saying, and offer encouragement.
  • If you haven’t understood fully, rephrase what you have understood and check to see if you are right. The person’s reaction and body language can be a good indicator of what they’ve understood and how they feel.
  • If the person with dementia has difficulty finding the right word or finishing a sentence, ask them to explain it in a different way. Listen out for clues. Also pay attention to their body language. The expression on their face and the way they hold themselves can give you clear signals about how they are feeling.
  • Allow the person plenty of time to respond – it may take them longer to process the information and work out their response. Don’t interrupt the person as it can break the pattern of communication.
  • If a person is feeling sad, let them express their feelings. Do not dismiss a person’s worries – sometimes the best thing to do is just listen, and show that you are there.

Body language and physical contact

  • Non-verbal communication is very important for people with dementia, and as their condition progresses it will become one of the main ways the person communicates. You should learn to recognise what a person is communicating through their body language and support them to remain engaged and contribute to their quality of life.
  • A person with dementia will be able to read your body language. Sudden movements or a tense facial expression may cause upset or distress, and can make communication more difficult.
  • Make sure that your body language and facial expression match what you are saying.
  • Never stand too close to someone or stand over them to communicate – it can feel intimidating. Instead, respect the person’s personal space and drop to or below their eye level. This will help the person to feel more in control of the situation.
  • Use physical contact to communicate your interest and to provide reassurance – don’t underestimate the reassurance you can give by holding the person’s hand or putting your arm around them, if it feels appropriate.

Summary

Adult social care services are always looking to improve their ability to communicate with people with dementia. Managers of adult social care services are well advised to bring to the attention of their staff and carers the tips on communicating with people with dementia produced by the Alzheimer’s Society.

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

 

Support for providers to comply with the General Data Protection Regulation


Given the amount of information available to increase awareness, most providers will now be aware that GDPR comes into force on the 25th May 2018. That being said, if readers carry out a trawl of the internet, they will find that apart from the Bettal GDPR Compliance Tool there is no other company advertising support with compliance designed and tailored specifically for social care services.

The purpose of this article is to give readers an overview of the requirements of the General Data Protection Regulation and how the Bettal GDPR Compliance Tool can support providers to achieve compliance.

Essentially, the responsibilities of managers are contained in the GDPR Principles.

GDPR Principles

Article 5 of the GDPR requires that personal data shall be:

(a) processed lawfully, fairly and in a transparent manner in relation to individuals;

(b) collected for specified, explicit and legitimate purposes and not further processed in a manner that is incompatible with those purposes; further processing for archiving purposes in the public interest, scientific or historical research purposes or statistical purposes shall not be considered to be incompatible with the initial purposes;

(c) adequate, relevant and limited to what is necessary in relation to the purposes for which they are processed;

(d) accurate and, where necessary, kept up to date; every reasonable step must be taken to ensure that personal data that are inaccurate, having regard to the purposes for which they are processed, are erased or rectified without delay;

(e) kept in a form which permits identification of data subjects for no longer than is necessary for the purposes for which the personal data are processed; personal data may be stored for longer periods insofar as the personal data will be processed solely for archiving purposes in the public interest, scientific or historical research purposes or statistical purposes subject to implementation of the appropriate technical and organisational measures required by the GDPR in order to safeguard the rights and freedoms of individuals; and

(f) processed in a manner that ensures appropriate security of the personal data, including protection against unauthorised or unlawful processing and against accidental loss, destruction or damage, using appropriate technical or organisational measures.”

Article 5(2) requires that:

“the controller shall be responsible for, and be able to demonstrate, compliance with the principles.”

Care Services will need to register with the Information Commissioners Office(ICO).

As can be seen the data controller will need to have systems and documentation in place to address the principles and requirement of GDPR.

Data Controllers will need to demonstrate that:

  • they have a legal right to hold information on service users;
  • they are aware of the kinds of information they hold on services user’s staff and volunteers;
  • the information they hold is accurate and up to date;
  • personal data collected is adequate relevant and limited to the purpose for which it is being processed;
  • people are aware of their rights to access information that is being held about them;
  • appropriate security measures are used with the processing and storage of people’s personal data.

Bettal GDPR Compliance Tool

The Bettal GDPR Compliance Tool designed specifically for social care services has taken months to develop. The Tool draws heavily on the GDPR Principles, compliance guidance produced by the Information Commissioners Office and their own Self-assessment (ICO).

The Tool is designed to:

  • Enable managers to understand their obligations to the GDPR.
  • Provide you with the documentation you require and guidance to meet the GDPR.
  • Audit and check your compliance to GDPR.

The Tool includes:

  • An Implementation Plan.
  • Data Processing Audit Register (Form).
  • Example Privacy Impact Assessment (Form).
  • Example Privacy Impact Assessment (Form).
  • Obtaining Consent (Policy).
  • Information Governance (Policy).
  • Data Breech (Policy).
  • Security of Personal Data (Policy).
  • GDPR Staff Training (Policy).
  • Duties of senior Person Responsible for Compliance to GDPR (Guidance).

Overall the contents of the Bettal GDPR Compliance Tool includes over 30 documents.

Please click here for further information on the Bettal GDPR Compliance Tool where you can download free samples and purchase the full package.

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