July’s CQC trade association meeting covered some useful topics. See slides: July Trade Association Meeting Slides

Latest updates & publications

Since the last meeting, the CQC have following published the following:

• The latest COVID-19 Insight issue 12 report
• The CQC response to the consultation they held on Changes for more flexible regulation
• Two reports from their provider collaboration reviews:
  • Ensuring the provision of cancer PCR report
  • Care for people with a learning disability living in the community during the pandemic
• CQC’s equality objectives are in line with their new strategy and core purpose
• Their annual update on the safe management and use of controlled drugs

Reflections on the publication of location level death notification involving COVID-19 from care homes

CQC feedback:

• The data was published as planned as part of an insight report on 21 July
• The CQC contacted the 23 providers with more than 30 deaths and also some homes with slightly fewer than 30 deaths, to offer support in the event of press contact and interest; the providers were very grateful for the support.
• The CQC felt their key messages worked & landed well; they observed that they did not receive the level of press interest that they were expecting
• They received positive feedback from some providers on how the release was managed
• They said that they sent 15,317 emails with data to providers and less than 30 provider errors were reported. They found that where errors were reported, this was mostly duplicate information; they feel the data was mostly accurate & that their QA process was good.
• They are doing an internal lessons learned and welcome feedback from trade associations and care providers

Reflections from NCF:

• Agree that the coverage was relatively balanced & the context report was very helpful – grateful for the opportunity to contribute to that
• Concerns about the process having no accuracy check built into it, plus the info being published for services that were no longer registered
• Felt hard to get a really clear picture of the media plan – we were not expecting direct communication with local and regional press
• Lots of ongoing, longer-term data implications also – we need to re-look at the data relationship with the CQC, especially in relation to the new way of regulating

Liz has followed up with an email to the CQC with these reflections

Action for members: the CQC would welcome feedback from care providers – please let us know if there is anything you would like us to feedback

Other reflections:

• others felt the coverage did achieve a balance, although the headlines were still negative
• a rather optimistic presentation of the response from providers; Registered Managers were very anxious about this publication, were scrambling to respond, faced accusations from and difficult conversations with families and were hugely worried about the potential press coverage. It had a huge impact on RMs & their mental health
• There was a strong view that the CQC also have a duty to report on more positive aspects of care homes more strongly – for example, a focus on the outstanding sacrifices of staff and all that they have done during COVID, as well as their duty to be open on transparent on this data

Roll out of Home Care inspection using remote technology

CQC is committed to developing this approach, following a successful pilot in virtual inspections of some home care services. Many thanks for the support on the pilot to any who took part.

It will be an additional, optional tool for home care agencies and some extra-care locations; on-site inspections will continue to happen as well. The pilot found that it was a robust approach & allowed for a more flexible process, especially in a pandemic & for the digitally ready, it lessened the burden of inspection.

There is very little difference to an on-site inspection & it will be rolled out imminently; it is important to be clear that this is not a new methodology, just an approach using remote technology to run the same inspection methodology.

Home care agencies will be able to discuss using this approach if they have an existing rating and do not have any existing enforcement. If there are indicators of closed cultures or it is not possible to engage with people using the service or staff virtually and this needs to be face to face, then this approach will not be an option. They also recognise some home care providers are not digitally equipped & this would be too much of a burden.

Supported Living and Shared Lives are out of scope for this approach

Discussion:

• UKHCA – very supportive, pleased to see reference to ratings reviews as this is a real problem
• Why is Shared Lives out of the scope? CQC response: the rationale is that they are worried that people would not be able to be involved properly; no services for people with LD will be able to use this tool; they need more info not less and need to hear more from the voice of the people being supported
• How does it fit with the wider dynamic approach? The focus on risk makes it very hard to be very useful. CQC response: they see this as the start of the journey and we should see it as a positive

• Raised issues and concerns from members about their wider regulatory approach. CQC response:  the CQC is in recovery from the pandemic like everyone else; they need to be honest about their lack of capacity to return to a schedule of inspections and they have said they will use focussed inspections to be able to review ratings. They simply will not be able to inspect some services and they are being honest about this for 21/22, which is a transitional phase

• They will start to pick up on re-rating more smartly as part of this approach.

• Asked for more clarity on this transitional phase, as it was not familiar to me, and asked for a workshop to consider the issues with the new regulatory approach and the focus on smarter, more dynamic regulation and the monthly review process. CQC response: will arrange a workshop

CQC’s proposal for a single assessment framework

The CQC presented the same framework as the one they shared for considering the assurance of Local Authorities; they are aiming for it to be more clear & transparent and responsive. It still has 5 Key questions & ratings, but they are working towards a one single framework for all the different sectors & services they regulate & assure.

They have been exploring how they can use the existing ‘I’ statements to bring to life in a human way what good quality looks like to the individual? How to demystify what quality is? They are seeking to do more of their work based on what people tell them & are hoping this will encourage more structured feedback e.g., a scale for the ‘I’ statements. They are also looking at breaking down the ratings & KLOES.

Seeking to align the quality statements to the ‘I’ statements and to simplify them – the quality statements currently run to 70 pages; they need to draw out what good looks like, be more compelling & at the right level, putting people at the centre whether a small care home or a large ICS.

Mapping the ‘I’ statement to the quality statements: they don’t map very well so far as the regulations are focussed on compliance so they are thinking about how to set the bar at the right level. Aiming to use the Making It Real ‘We’ statements to articulate what the regulation requires.

Evidence categories: 335 KLOES and prompts across all health & social care work that they do; CQC believe these need to be simplified, especially as some providers work across both sectors. Key questions for the CQC: what do they need to know to test if the service is good? what is people’s experience? what do we hear from staff & leaders & stakeholders?

More clarity on required evidence: what is enough for inspectors? The CQC must support them in enabling them to make judgements as well as making it more helpful for providers.  More clarity is needed on how the quality statements map to the legal requirements/ regulations, for both providers and the public. The CQC are also considering how to be more granular on judgements with scoring; they currently have ratings at KLOE level, can they break it down to the topics within the KLOE & keep the evidence up to date to nudge improvements and eventually nudge the overall KLOE rating?

See the slide graphic on slide 15: the red line shows where it is generic for all services – providers, LAs and ICS. Below the red line, it gets more specific for the service involved – e.g. training needed for an LD service will look like xxx. They are exploring how to score the quality statements & triangulate all the evidence for each topic in the KLOE & the rating e.g. where does what we have found sit on a continuum of 1 – 4 scale? They are already using this approach in the monthly monitoring approach.

The CQC have pulled out the relevant ‘I’ statements mapped to the 5 KLOES; none of them map to ‘Well Led’. Perhaps the ‘I’ statements from the workforce perspective will help with ‘Well Led’.

The CQC is seeking to make the framework more human and unite the whole system; aiming to make provider regulation less burdensome.

There is one slide per KLOE Key question (see slide 17) – is the language, right?

Evidence required from providers (see slide 19) – Helpful to think about this as a digitally supported tool which is dynamic – eg in the example below, making sure the reference to the NICE standards is the right one for the relevant service type for good practice

Q&A

• If the CQC want to be transparent, how about a guide for staff to demystify CQC & helping to encourage engagement from staff – about good and bad issues
• Thinking about the ‘we’ statements – the wellbeing of teams impacts on the quality of care hugely
• Where are the outcomes in this thinking? Think a workshop on this would be great.

Overview of ratings

Big curtailment of usual inspection activity last year so there has been little change on the ratings picture. 

Operational Update

Inspections undertaken 17/05/2021 –15/07/2021

• 23 – Infection Prevention and Control and Designated Settings
• 2 – Outbreak
• 989 – Risk

Total – 1014

Mandatory vaccinations

Go Live 11 Nov 2021; first jabs needed by 16 Sept.

Guidance due on Friday (Post-meeting note: Published 4 August)

The CQC’s approach is to try to make it as easy as possible for everyone; it will be business as usual in regulatory approach; they will be asking questions at registration on systems & process in place to make sure they comply;

For monitoring: will be adding a brief question into the PIR about the system & processes in place to assure compliance

For inspection: will be looking to see how systems or processes are working

They will tackle breaches in the same way as any other regulation, in a fair, proportionate way  – eg take a medically exempt person – need to be confident that the info has been recorded, and PPE in place

They will not need providers to take a copy of a person’s app/ evidence to show they are exempt/ vaccinated; for staff, they may look for more detail.

CQC don’t want to prescribe how providers collect & store this data.

(Post-meeting note: see CQC statement published here)

CQC are also seeking to influence the role of NHS employers and reminding them of their duties to work collaboratively within the inspection framework!

Discussion:

• Can we ask SfC to capture data on how many staff are lost due to the policy?

AOB

Regulatory approach

The wording of the monthly statement being issued feels like a real deficit statement and does not inspire confidence – can it be revised? No – the statement is not intended to be a deficit statement but not a promise either; the wording took ages & won’t change, it has been through many iterations, with extensive legal advice

Their view is that nothing has really changed – they have always been risk assessing and now it is more consistent

The improvement challenge

They acknowledge that they won’t be able to go out to all services where there may be improvement but the focus will remain on risk

Happy to have a dedicated session on their regulatory approach

Review of CQC regulations

Are they still appropriate? Should they be extended for the next 3 years?

Note: I asked for the types of data that the CQC use inform their assessment in Adult Social Care; it includes:

• CQC Judgements: Current ratings, compliance with regulations, outcomes from monitoring activity and length of time since the last inspection
• CQC received information: statutory notifications, complaints, safeguarding, whistleblowing and Give Feedback on Care
• CQC activity: any regulatory activities currently in progress

They also said:

In addition to this, the starting point for any service to have a public statement is that it must be rated as overall good or outstanding.

The type of data and the way that we assess data will change over time as we further develop and refine our interim approach to monitoring for 2021/22. We may also change the type of data we use as we learn about its effectiveness in identifying where to take regulatory action.

As you know over the next 6 months, we will be inspecting a number of services with a public statement to further test and refine our intelligence model and approach to monitoring services. It is likely that the outcome of these inspections will help us to refine the way that we review services further; meaning that the data we assess and the way that we assess it may change.

Thank you also for your helpful feedback on the language we currently use in the public statement. With this statement we are balancing the need to give assurances to the public that we are monitoring the quality of care they receive and for providers give assurance that we’re confident their rating reflects the quality of care they are delivering.

Before launch, we held discussions with a number of trade associations to describe the approach and purpose of the public statement. We have really valued trade association feedback on this work to date and will use this and any further feedback to inform future work we will be undertaking to develop our regulatory model and information we share from our assessments. This work will be taking place over coming months, and we value your and the sector’s involvement in this.