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Update from CQC Trade Association Meeting – 15 December 2021

CQC Regulation update – Sue Howard

Over the next couple of months, the CQC has announced that they will not be inspecting hospitals & GPs because of the pressures they are facing with Omicron and the vaccination programme.

CQC has also been looking at ASC priorities in light of that decision. They will focus on 3 key areas:

  • Inspect emerging risks – using their thresholds, with management review process to manage those thresholds
  • Completing more IPC inspections – targeted, using the IPC tool & responding rapidly to designated setting approval within 48 hours.
  • Looking to create more capacity in the system – e.g. re-inspecting services rated poorly, where intelligence suggests an improvement & also inspecting services that have yet to be rated

NCF: Mentioned the issue of shared risk across the system and that moving risk out of hospital to providers is not helpful. This a fundamental issue that needs a shared risk approach, not a wholesale move of risk onto providers.

CQC: The decision to admit must rest with the registered provider & the RM;  if the needs of the person they are being asked to admit sit outside the core client group, they should say so. It is really  important that providers tell the CQC if these situations arise, and if the risk has escalated & how they are managing the risk; when looking at effectiveness of the assessment of the risk , it is always better to hear from the provider than from a whistleblower / family. The focus will be on impact of quality of care – how is the rest of the system supporting them – the LA, the CCG, the DNs etc?

Other discussion: colleagues mentioned that teams of CQC inspections were doing benchmarking  of outstanding inspections – the CQC are not doing this and if it is happening with individual inspectors, please raise it with the regional heads.  What they have been doing is work in services that are good & outstanding & doing a QA sample of inspections; does not need a team of inspectors to do this.

The care hotels issue:  what is the CQC position on this?

CQC response: Care hotel guidance exists; they emerged as a concept in height of pandemic to get temporary care packages for people ready to be discharged from hospital & generally one home care agency is commissioned to provide the in-reach support on a block basis. They are not registered locations in their own right, it is the home care agency that is registered to provide in-reach home care to the people staying for a short periods of time. It is helpful for LAs/ providers to tell the CQC where care hotels are operating and the CQC has a series of prompts for inspectors to talk to the home care agency in a supportive way  eg, reminding them about access to GP support , access to equipment etc & the agency should update their statement of purpose to say they are providing support into a care hotel and they should provide details on their exit strategy plus any staffing issues.

Care hotel Q: Is there any requirement for it to have a manager on site? One provider raised the example of one in Cornwall with staff coming from Basingstoke – will be hard to have oversight of staff. CQC view : the home care agency does not have to have a location in the area where the care is being provided.

Q? re the approach to re-inspecting RI services – is it only a capacity issue and where placements are not happening due to rating – or is it wider?

CQC response: need to do a bit more work on this, but if the RI rated service can demonstrate that the rating is causing an issue in the area, then it will make them a priority , especially where the CQC is also contacted by other stakeholders. The first priority though is to create immediate capacity in the local area, but long term aim is to return to the RI services to get them re-rated. Intelligence is key – eg a positive monitoring call or other intelligence.

Intelligence Review – Sara Duggan

Updated ratings & trends – see slides starting at page 5

Overview slide (page 6): Highlights the purpose

Current ratings slides: July 2021 compared to March 2020. Very similar; this has not been a standard period & the inspection approach has been more focussed & they have published fewer ratings. 85% Good or outstanding overall & by KLOEs

Ratings by service type: little change from March 2020 – July 2021; nursing homes have a higher proportion of RI & inadequate

Market trends: Nov 2020 – Nov 2021 – changes in registered ASC services & service users

England picture: little change in number of care homes & nursing homes; in Dom Care Agencies, they are seeing an increase of 6% – 8% – occupancy challenges may contribute to the increase in DCAs?

Regions: East Mids = small decrease in care homes and small increase in DCAs, East of England = increase in nursing homes and DCA & decrease in res care homes. London has biggest increase in DCAs.

Feel that the data mirrors the Home First strategy in many areas – the focus is on DCA capacity & commissioning in the community with the Home First philosophy

Q:Any feel for the data for the rating picture post July 2021, when the workforce pressures really started to build? Not really, but need to keep a close eye on the situation. 

Q: Any feel for demand? Not really but may look at it in future. Will build into the LA assurance framework

Any questions just ask!

Skills for Care Workforce data set – Eliza McConnell & Dave Griffiths Workforce Intelligence Team

See the slide set from page 22

Background to the workforce data set; this is an online data collection service, which collects data from 20,000 care providers – about 47%. In return, they get some useful online tools – eg benchmarking

Interesting trends: occupancy levels have fallen, big increase in DCA jobs – 40,000 – 7.4% increase; staff sickness has nearly doubled in the pandemic; vacancy rates dropped in the pandemic but as the world opened up, rising to above pre COVID – Nov had the highest vacancy rate this year at 9.2% 

Workforce Intelligence visualisation: supports evidence to Govt – eg Health & Social Care Select Committee  & the Migration Advisory Committee.

Sharing with the CQC: when providers give permission, some of the data is shared with the CQC. This is not new but is being reinvigorated to reduce duplication

Screen shot of the type of data shared: Opt in tick box; can change your mind whenever you like; drop downs to explain why the data is hared & what is not shared;  data is shared on a monthly basis 

What does the CQC do with this data?

See the slide below; understand trends in the sector at a macro level, but primary use is to construct indicators to monitor individual  services – staff vacancy rates, turnover rates & staffing ratios; they benchmark across similar services to see what you might expect versus what there is. Keep it simple with a RAG rating. CQC combine the SfC data with the Provider Information Return data.

Looking to extend the info they use from the SfC data that they share with inspectors – an extra 80 items!!

Q: Any triangulation with ONS labour force data? No as it doesn’t reflect ASC too well in terms of level of granularity; the sample size is too small so they don’t use it

Operational update – Alison Murray

VCOD #1 – now live with this; self-exemption time frames extended till end of March 2022 – current system not working very smoothly; as of yesterday 4 locations with a breach of Regulation 12.3; 3 of the incidents = a requirement notice, the fourth one is tied up in other significant enforcement activity as there are wider issues.

CQC has heard examples of visiting health professionals not being supportive & putting RMs in a tricky position, so CQC has escalated locally as needed & contacted NHSE

VCOD#2 – widening the scope; regulations passed last night, understanding they will go on the statute book at beg of January  & be effective from 1 April; CQC realise there are challenges with employment law for those staff needing 12 weeks’ notice. From the day after the regulations are made, in care homes, new starters can work 21 days after first COVID jab – but do need second jab within 10 weeks of the first dose.

***** POST MEETING Note – the DHSC has announced its plans to revoke all the VCOD regulations; this is in train but has not yet happened.  ****

DHSC is engaging a lot on the new batch of guidance for VCOD#1 with a number of workshops – one for DCAs & one for ECH & SL services. The regulations are not very clear cut but they do need a registered provider (employer) to hold to account for those employed or engaged to deliver the regulated activity face to face. Pure DCAs are easier than SL & ECH services. Guidance is due to be published early Jan when the regulations are made.

Role of CQC inspectors in this? In ASC, all their inspectors are double vaccinated & are not allowed to do ASC inspections unless double vaccinated & boosted if available.

Q: Do the VCOD#2 bring a risk around re-institutionalising certain settings? Not if the CQC  can help it! To fall in scope, need to have a registered provider who employs or engages the person for the purposes of providing the regulated activity; so, for example, if SL service user has a direct payment to pay their neighbour for care & support, it is entirely out of scope. 

Exemption: the DHSC form is for self-exemption & the DHSC would prefer people to use it. Now valid until end of March. Post end of March, not valid. The process for a formal clinical exemption is via 119, application, review, decision. If found not to be exempt, then need to be vaccinated or move to a job out of scope or not do current job. 

Designated settings: it is still  a policy desire that people infectious with COVID go to one if leaving hospital/ coming from the community. Awaiting updated guidance. 

Visiting: updated guidance yesterday evening to reflect Omicron risk; it is still saying visits should be facilitated etc , allowing 3 named individuals plus an essential care giver but with the aim to reduce the traffic into care homes. Visits out: people need to test every other day  every day once back  / isolate if not double jabbed – tricky! Lots of response & activism – CQC realise it is very tricky, logging concerns & talking to providers

*****POST MEETING NOTE – the guidance has changed again****************

Workforce challenges : the CQC always look at this as part of their monitoring; they are trying to make it more structured and have a workforce survey tool for all ASC inspections & during the monitoring calls.  They will share the questions.

Discussion: isolation can be done for an individual’s best interests but not for the benefits of other people; if people without capacity cannot isolate, where does it leave providers? The PHE advice is to let the person wander free & isolate everyone else.

CQC: providers have to make a balanced judgement that looks at the bests interest for the person – plus take some advice

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