Not-for-profit quality care for over 25 years

Update from the CQC Trade Association meeting – 27 January 2021

Slides from the monthly CQC Trade Association meeting held 27 January 2021.

Download the slides here.

Strategy Consultation – Tansy Evans and Sam Wallace – ends 4 March

  • Reason: purpose remains the same but the world is changing; renewed focus on inequalities and system working – look at how health & care services work together. 4 themes, underpinned by cross cutting themes – health & care systems & reducing inequalities
  •  Theme 1 – people & communities; regulation driven by needs and informed by experience and what matters – want to focus more on feedback from people; hold systems to account for the quality of their care. Asked how will this be balanced to ensure a positive picture as well as negative? CQC: Need a range of views and more balanced sample; proactive work to do this and how we listen to people and help the public to understand ratings and expectations so they can see if they are exceeded not just met. The disgruntled should not dominate!!
  • Theme 2 – smarter regulation; more dynamic, flexible and future proofed. Use inspection alongside other methods to assess. Future proofed regulation; making their info more useful and timely – e.g. more regular ratings, better info
  • Theme 3 – safety through learning: want to promote openness about safety to improve and learn from mistakes; culture is key. Need a standard definition of safety and better understand of risk, a learning approach that avoids blame and improves
  • Accelerating improvement- more proactive role to facilitate improvement alongside regulation; collaboration, improvement coalition  for the sector, find gaps and fill them, hold improvement conversations and where to find support.
  •  Cross cutting themes: Health & care systems & tackling inequalities – asked CQC about what that looks like: can their regulation of health properly support their regulation of care?
  • Engaging in the consultation – want to hear from as many folks as possible – please support CQC to join our conversations

Consultation on changes for flexible and responsive regulations – Vicki Priest

  • 8 week consultation which proposes specific changes to how they regulate and rate, to be more flexible and responsive
  • COVID has shown the limitations of the current system – want to move to a different way of rating, update them more often, be more responsive and proportionate
  • Want to assess quality with a wider range of regulatory approaches, not just on site or full inspections; want to update ratings via focussed inspections; want to update in certain circumstances based on other info without a site visits
  • Want to move from the fixed schedule of inspections to be more risk based and flexible
  • Simpler ratings for GPs and NHS trusts.
  • Future consultations: want to move away from formal consultations and have an ongoing approach to engagement rather than fixed periods of consultation

Questions:

  • Will fees be more flexible too?
  • Will the changes to GP ratings affect social care?
  • Will the new agile approach reflect improvements in quality and well as deterioration? How will they get info about quality both ways? Concern the result will drive down ratings not support recognition of improvement
  • Moving from formal consultation is a problem – too easy to miss informal processes of engagement.

Virtual Home Care Pilot Evaluation – April Cole

  • Trialled virtual inspection approach in dom care and EC housing services
  • Trialled 48 inspections in the pilot – good or outstanding rating previously; good spread of size and location
  • Evaluation of the pilot – feedback from inspectors and Experts  By Experience
  • Findings:
    • better engagement with people using services (increased  the number by 70%) and better support from the Experts by Experience and from the CQC NCSC call centre.
    • Very positive feedback from EbyE and CQC team;
    • time saving on travel;
    • positive feedback from inspectors on a range of communication channels, good engagement with dom care staff – increased the number by 28%
    • Evidence provided – as robust as in physical inspection;
    • mixed views on the insight into culture of the service by not going to the office;
    • file sharing mostly worked – bit of a struggle to start with
    • provider feedback – worked OK but do like the face to face interactions; IT challenges and file sharing tricky
    • inspector feedback – a useful tool to add to the mix, quite positive, IT challenges and file sharing, also missed the face to face element and the flow of evidence could be tricky

Climate Resilience of care settings: Research Project  – April Cole

  • CQC been supporting this for a few years – UCL, Oxford Brookes and LSHTM; phase 1 study in 2019 looking at 5 care homes in London to mitigate impact of rising temperatures and overheating.
  • Phase 2 has been delayed – want to start now – need 50 services across London, Manchester & Newcastle
  • Participants will get tailored advice from experts on how to improve resilience in hot weather and heat waves

Notifications – Warwick Asburner

  • Project to improve the quality of info from statutory notifications
  • Overhauling the stat notification forms – done some user research with providers, especially re COVID, LD
  • Progress: Launched revamped SN16 death notification form and the SN18 DoLS form (word versions, online one soon)
  • Poor quality info – using old forms, missing info such as location ID or name, changing forms before they are submitted. Seeking to solve these problems
  • Looking for opportunities to talk to providers

Provider Information Returns – Louise Chapman

  • Plan now to restart in March with a reduced version of the PIR
  • Will target areas less hit by outbreaks
  • Trial for a month in March to test the reduced version – we will see the wording in Feb
  • Will resume fully in April

Inspection priorities – Sue Howard

  • See slide – Supportive, Reactive & Proactive –
  • Supportive = IPC inspections, no limit on the number of these that they will do; deliberately increasing these, especially those services who have not yet had one
  • Reactive = IPC risk, whistleblowing, rises cases of COVID in a service (30% trigger – of resident capacity); also urgent inspections based on other risk as ever; will monitor other services via their management approach system
  • Proactive = designated services; also inspecting to create capacity in a local system ( the inadequate rating example, where re-inspection will help or a new service)

IPC and Designated settings – Alison Murray

  • The issue of threats of reporting to the CQC for
  • Approved 144 Designated schemes, still a few LAs who haven’t found any settings or have other arrangements.
  • Prioritising as soon as is humanly possible
  • Very aware of the anxieties and concerns with designated settings – reinforcing the point  that it is the RM’s decision to admit – or not
  • Review of designated – a light touch process where after some time, the inspector will look at all the info they have since it became designated, then a supportive call to the service
  • Indemnity scheme – very targeted, very time-limited, packs went out to LAs last night, DHSC panel to assess applications; CQC has written tot eh 144 locations designated so far to tell them
  • IPC inspections – 889 IPC specific inspections – prioritising certain risk factors – dementia specialism, small to medium services, those services that did not have an outbreak in wave one  – aiming to get to these services first; getting help from PMS colleagues to increase the IPC inspections
  • Developing the IPC methodology of SL and ECH services
  • Care hotels – will be a thing, will fall under dom care sphere of operation; will do a call to the DCAs supporting care hotels once local systems tell them about it; vast majority are offering hotel accomm and a dom care agency will go in as it would work in the person’s own homes; some hotels have registered as care home s- tight conditions, time limited

Liz asked the question re levels of deaths – 1705 this week; CQC response: all very concerned, especially the minister; new variant requires super IPC and PPE vigilance; all other ideas welcome

Liz asked about the statement re COVID positive staff working with COVID positive residents – CQC response: this was in response inapproporiate local PH advice; not happening very often but mooted as an option in some areas – systems been advised to NOT do this; If any members are asked to do this, please can they tell their CQC inspector.

Download the slides here.

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