The September CQC trade association meeting covered some useful topics. See slides: September Trade Association Meeting Slides.
CQC Data Strategy – Helen Louwrens
- The CQC want to hear the voice of people and communities when looking at services. This can only do be achieved if data is optimised. By data, they mean anything that tells them about quality. Doing this at the provider level is the basis of what they can do at a systems level.
- They are creating a new Data and Insight Unit as part of the strategy. This will deliver better intelligence to CQC, providers and the general public. As part of the strategy, there will be a data acquisition plan, with the aim to stop duplication of data collection in the sector. There will also be an investment in technology to make it easier to use and share data. This technology investment will include a new provider portal, a new digital interface for inspectors and a new enterprise data platform. The new digital interface (new provider portal), will be co-produced with providers.
- The enterprise data platform will deliver a suite of cross-sector products that enable joined-up analysis across services, core providers and system boundaries.
Q: Will the provider have access to the digital interface the inspector holds on their service?
A: Yes. It’s their view into the enterprise data. Providers will see data from the provider interface.
Q: Will these/all or some, be open to others such as LAs to view?
A: Yes, the plan is to allow this. Work needs to be done on this. Want to avoid duplication across the system. LAs would be unlikely to be given access to the inspector interface – rather there will be relevant data pushed to LAs.
Q: Does this mean CQC (&inspections) will be run by algorithms? Supplying data once and using it many times would be good, but this hasn’t happened with local authorities. Social care providers simply do not have the time, or the funding to do this time and again. How will this affect factual accuracy? It is already difficult to raise issues around this.
A: By data, they mean anything that tells them about a service. Ambition is all of it is pulled together into a dashboard to help inspector do their job. This is about intelligence and data, helping to inform consistent decision making. The inspector still retains the power to make a judgment on the information – an algorithm doesn’t make the decision – the inspector does.
Q: How do providers ensure that any data collected can also be analysed and used to highlight good practice? How does data feed into inspections etc?
A: Acknowledged this and said they would be seeking to do this in order to support providers. Hoping that having the dashboard allows them to see the good practice in one place and therefore make decisions about services that are improving. This will be made clear to inspectors. They aren’t simply looking for bad.
Q: Concerns about the use of data and algorithms – what happens when the data is not accurate? How do we raise with the system? Similarly, big push across the sector for data, including ICSs.
A: We need to be very clear about how data is being used and collected. Trying to work with other players across the system. In terms of inaccurate data, there will be more scrutiny due to the transparency of the data. Working through the processes to challenge data which providers think is inaccurate. For instance. Increased falls might not be bad – might be the result of better processes with data or simply people living being enabled to lives more independent lives.
Q: CQC need to be very careful about how data is weighted; people’s perceptions are not the same as the reality and sometimes perception is about the amount of money given by commissioners to providers and thus providers can’t do more than what they are doing. Need to be careful how data is treated. Providers must be able to have sight of data and be able to challenge it if wrong. Balance, transparency and weight of data are very important.
A: Agrees – will be looking at commissioning practice – it will be very easy to see this in an area because CQC will see similar trends across providers. They will be able to take action at a systems level.
Q: Will you consider filling in data gaps on social care? Collecting any additional information that is not already there that can help the sector. Compared to health data there are huge gaps that would help with research. This would be data that is beyond what is needed for regulation.
A:Are reticent to do this but working with others looking to join up data.
Q: What training will be given to inspectors to ensure they can analyse the data effectively + culture change as well?
A: Looking at what this will be to make culture change and use the tools they get. They are working on this.
NCF raised the issue of data and workforce crisis – going to come back to this in the State of Care Section.
NCF’s suggestion: It would be good if NMDS could be incorporated, if that was to cover the bulk of the workforce it would be helpful in making representations for funding, etc.
Registration Update – Amy Jupp
- 54,000 applications per year. Of this, 10% are not valid/needed, 20% rejected, 5% withdrawn, 2% refused and over 60% approved. The backlog from 12 weeks to allocation is now 6 weeks to allocation.
The CQC are happy to come to speak to providers about registration if asked
Domiciliary Care Services
- CQC have a new way of working, that focuses on document completeness and an accuracy check.
- The quality of applications is improving, there are quicker assessments and decisions when the applicants are ready and the consultancy firms are changing documents to support providers and provide better support.
- There are areas for improvement, and they will be looking to improve the website.
Q: Trade Associations are seeing issues with inconsistencies in registration officers and different services having to do different things or take a different amount of time.
A: CQC says that domiciliary care applications are often of poor quality. Some copying and pasting policies from other organisations for instance. But the quality is now improving.
Q: Do CQC cross-check applications with Companies House? I have picked up errors in applications that have been shown to us.
A: Yes, all of them are.
Services for people with a learning disability or autistic people
- The CQC are doing some work with providers providing services for people with a learning disability or autistic people. In order to help them work out what registration is needed – particularly in large supported living services. There are three workstreams, pre application engagement, supported living services and shared internal relationships and consistency.
- Some people on the call said that they had been told that registration inspectors will not talk through in advance. CQC said for providers to report registration inspectors who do this or take months to change an address
Pre application engagement – Would like us to go back to providers and ask them to contact CQC before they develop a new service to ensure that it is developed in the correct way in line with regulations.
Q: Is this just about LD services or all services? If the former, this is a major change.
A: The focus is on Autism and LD services but they are happy to talk about other services.
The next move will be talking to commissioners of these services as well. CQC has also been meeting with family members.
CQC would like us to ask the following questions to providers:
Is there anything missing that you think we should focus on for Personal Care applications?
Do you have any feedback from DCA providers for registration?
How can we encourage new and registered providers to engage with us before they build services for people with a learning disability and autistic people?
What are your successes and blockers with Commissioners?
As we design our new provider digital journey – what would you like to see in an application portal?
As we formalise our winter plan, what applications do you think we should prioritise?
Operational Update – Alison Murray
- The operational update focused on workforce pressures. The CQC are aware of the workforce pressures. All trade associations raised the question about what CQC could do. The CQC agrees that we are all raising the concerns – including them. The CQC have spoken to the DHSC about this – DHSC + Treasury wants more evidence. CQC is looking at its data to try and back up the provider argument to DHSC and treasury. They asked for copies of any survey’s organisations have done – NCF has sent in the NCF survey.
- CQC know that the lack of nurses is a real problem on services atm. There have been examples of NHS Trusts deliberately recruiting nurses who don’t want the vaccine from care homes.
- CQC acknowledges the issues about the workforce and is thinking of other ways to put pressure on DHSC: Thinking about registration for care workers – would that work? – lots of support for this but only with funding to set up, implement and operate.
- The £500m for workforce needs careful use. The sector needs to redesign how we train the social care sector to help them build the development & recognition of their skills & competencies and the qualifications that need to be an integral part of this.
- The sector is really struggling to recruit. Home care and others competing with hospitality – for example (Cornwall staycations) being offered £20/hr for caravan cleaners, work guaranteed to November and which then takes them into the Christmas party season so more work again in that sector. Lost cooks, housekeepers and carers. Home care services closing (voluntarily).
- The standards of training vary enormously – some providers find that those qualified to L3 not being competent and needing to be re-trained. It has got much better, but the numbers with accredited training need to be increased. This can be checked and become part of a CPD programme.
- Strong support from some for a workforce register. Concerned about the number of registered managers leaving. There needs to be a significant amount of money put in the sector in short term. The workforce as a whole has no sense of belonging, there is no respect or recognition given, media reports are constantly negative, current fuel crisis with care workers being told they are not key workers – society doesn’t respect the importance of the workforce. A register may help.
- NCF: In the short term, can CQC make a very forceful representation to DHSC about the need for money for the entire sector – beyond the scope of the Infection Control Fund – for all types of care and frontline workers. An extension still hasn’t been announced and it runs out tomorrow.
CQC response to above:
- Our independent voice role in the State of Care is the opportunity to draw attention to the issues.
- They will take the data they have now and raise it in meetings this week and push to get action from the government.
- They will start to think about registration and longer-term training.
State of Care – 22nd October
The CQC is using its independent voice for the public in highlighting their experiences of care to policy/decision-makers in the Government, Parliament local systems and the representative bodies of providers, in order to improve access to and drive quality improvement in services.
The CQC State of Care in 2021 will report on how the health and social care system has responded to the COVID-19 pandemic and what are its impacts:
- For the people who need care?
- On the people who work in the system?
- On the system as a whole?
Key findings include:
- The system did not collapse – the resilience of the system and its people has been remarkable and there is hope thanks to the vaccine. The pandemic has, however, exacerbated many of the issues and challenges from before COVID-19. Inequalities across health and social care is still a serious problem, particularly in access to care.
- Some people have been affected more than others, there is a backlog of care and staff across health and social care are exhausted.
- An estimated 4.5 million people have become unpaid carers since the pandemic began.
- Lessons have been learnt and local systems should build on service collaborations
We need information provided to enable people to make choices
NCF: On Discharge to Assess and Home First – there is a concern that hospitals are currently working towards home first targets and therefore won’t discharge to residential care settings when there is no home care available.