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

Supporting service users who suffer hearing loss


Action on Hearing Loss’ have published guidance for staff in residential care homes designed to support service users who have hearing loss.

The central thrust of the guidance is a recognition that deafness and hearing loss shouldn’t stop older people living well in residential care homes.  The guide provides practical tips and advice for care staff on improving the quality of care for older people who are deaf or have hearing loss.

More than two-thirds of older people have hearing loss. Around 71% of people aged over 70 have some kind of hearing loss. It’s estimated that 75% of people in a care home have hearing loss – and that this will increase to 80% by 2032.  Unaddressed, this can lead to social isolation and an increased risk of other health problems, such as depression and dementia. There is solid that hearing aids can reduce these risks, but the problem is that too many older people are waiting far too long to get their hearing tested or face barriers seeking help because of other conditions.

People who are deaf who use British Sign Language (BSL) may be at risk of loneliness and loss of cultural identity if they are unable to communicate in a meaningful way in BSL with care staff or other people in their care home.

How care staff can help?

1.0    Care staff should be alert to the early signs of hearing loss

The assessment of service users should offer service users the opportunity to have a hearing test. When new residents arrive at the home, staff should be aware of the signs of hearing loss, such as asking others to repeat things, failing to follow conversation in noisy places and behavioural changes, such as withdrawal from social activities.

A ‘Hearing check‘ can help identify people who may need a hearing test.

2.0    Provision of support to ensure older people get the most out of their hearing aids

Where a person has a hearing aid, staff should record this in the service users  care plan and make a note of other accessories that may be needed, such as replacement batteries or tubing. When someone is fitted with hearing aids by their audiologist, they should be provided with written instructions on how to operate and maintain their hearing aids.

Staff should carry out regular checks to make sure their hearing aids are functioning and fitted correctly. If hearing aids are worn continuously, hearing aid batteries typically last no more than a week and hearing aid earmoulds and tubing require regular cleaning.

3.0    Ask older people if they need help to communicate or understand information

If older people who are deaf or have hearing loss need staff to follow simple communication tips or if they need more communication time when receiving care, make sure this is recorded in their care plan.

In England, ensuring communication and information needs are recorded and met is a legal requirement under NHS England’s Accessible Information Standard.

4.0    Make sure the care home environment is welcoming for older people with hearing loss

A high level of background noise can make it difficult for older people with hearing loss to understand what is being said and participate fully in conversations and social activities. Carpeted floors, padded tablecloths and soft furnishings should be used wherever possible to help absorb background noise.

Older people with hearing loss may also benefit from assistive technology, such as hearing loops, personal listeners and flashing smoke alarms

5.0    Take account of the cultural and communication needs of older people who are deaf

Older people who are deaf are less likely to benefit from hearing aids and they may need specialist care and support that recognises the unique language and culture of the deaf community.

They may also need support from a qualified BSL interpreter, as well as help to contact family and friends and local Deaf clubs or other community groups.

Summary

Given that there is evidence that it is estimated that 75% of people in a care home have hearing loss, it is essential that care homes adopt a strategy to support service users who suffer with this problem. The guidance provided for staff by ‘Action on Hearing Loss’ should be followed. Hearing loss should form part of the assessment process, and actions to support service users contained in the care plan. This will ensure that service users can still retain quality of life.

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

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