Slides from the monthly CQC Trade Association meeting held 31 March 2021.

Download the slides here.

Slides include:

1. Welcome and introductions
2. DNACPR Report
3. Market Oversight (MO) and Updated Provider Guidance
4. Digitising Social Care Records (DSCR) Programme Overview
5. Equality objectives for 2021-2024
6. Operational Update with Q&A
7. CQC Engagement – Insight

Our Policy Director, Liz Jones, has highlighted points of note:

DNACPR Review – Carolyn Jenkinson

• The CQC spoke to more than 700 people and they did surveys and onsite reviews of records. There was evidence that DNACPR conversations were not always meaningful and this risked breaching their human rights.
• Most providers were unaware of inappropriate DNACPR decisions.
• The CQC were able to identify that there were some blanket DNACPR decisions. People across a range of quality groups (older people with dementia, learning disabilities etc.) who were not given the support they needed.
• They found a lack of awareness and confidence among people, families and carers about what DNACPR is and how to challenge it.
• There were also areas of good practice in the report, but overall, there were varied experiences.
• Following the Review, there were a number of recommendations:
  • Support families and representatives about DNACPR.
  • Comprehensive records of conversations.
  • Integrated care systems need to monitor and assure themselves of quality.
  • Health and social care providers to CQC to seek assurance that people are at the centre of personalised, high-quality care.
• There will be a Ministerial Oversight Group that CQC will be a member of alongside responsible bodies, voluntary sector groups and system partners. Each recommendation has a lead responsible person, working under the ministerial group. They are hoping to deliver on their recommendation’s and oversee the process.

Discussion:

• What can people do going forward, if they have any DNACPR issues? It is still happening – Yes – share your care experiences online, there is a responsible officer for each region to support this. It is also included in the usual conversations with inspectors. There is work ongoing into the 500 cases identified. It is a real problem for people with learning disabilities. They strongly encourage reporting this issue, real human rights angle.
• Are the ambitions of the recommendations enough? The ministerial group is really positive; shows a real drive – quite powerful; feels it is ambitious to get this to work across whole systems; we all need to play our part. Fair challenge – a balance between regulatory response with encouraging the conversation. We need to have a fair response and challenge poor practice across all parts of the system. CQC need to think about the new assessment framework to prevent this – single set of expectations which are really clear for all, especially in future role in ICSs.

Market Oversight Guidance – Stuart Dean

Updated Provider Guidance was published on 24 February 2021. Four themes have been updated in the guidance:

1. Interpretation of ‘likely’ – changing the language from ‘more likely than not’ to where there is a ‘reasonable prospect’. This change reflects legal advice since the start of the scheme and increases the protections of vulnerable individuals.

2. Provider obligations – making a clear link between the failure to operate with market oversight and falling back onto CQCs wider enforcement powers

3. Clarified CQCs existing powers – to be able to have confidential conversations if in the interest of vulnerable service users, prior to stage 6 notification; 3rd party conversations – can happen now without requiring provider consent – just notify the provider.

4. Changes in burden – switch from needing to obtain the prior consent of the provider to in certain circumstances, notifying them only. The reason for the change is that consent had been withheld for confirmatory conversations.

Discussion:

• Liz asked about the NAO report and whether the name market oversight reflects what the CQC does and is it all attributed to the CQC? Market Oversight has never provided an oversight on LA social care. The role of Market Oversight is to understand the financial sustainability of a small number of providers should there be cessation. It focuses on those providers who are too important to fail.
• Updated guidance – moved as far as possible within the existing legislative framework to manage big providers in a locality not just national – need to change the legislation to cover a different scope of oversight.

NHSX Digital Social Care Records (DCSR) Project – Pete Skinner and Natalie James

The focus is on social care records, not NHS records. Currently, 40% of Adult Social Care providers are using digital records – the rest are on paper. This causes an issue for data flow as well as access.

Objective: To ensure that all CQC registered social care providers have access to a digital social care record by March 2024.

We need to ensure that the digital social care records that are adopted:

a) Provide core functionality such as capturing information in real-time
b) Support measuring and monitoring of care quality
c) Provide a platform for innovation
d) Capture data in a way that enables bidirectional transfer between care settings and into a shared care record
e) Support the delivery of the Future of Healthcare and the Long Term Plan
f) Build on the tactical responses from COVID

Four work strands 

1. Market management and standards – including developing information around care records and identifying where there are underserved sections of the social care markets

2. Value creation and communication – building up a case for adoption. There is a partial evidence base of moving from a paper-based to a digital system. Make it clear where it will make sense for NHS to invest or for social care to invest.

3. Regulation – working with CQC LGA LA and DoH to move to a standardised way of collecting information and building this into the digital social care records.

4. Implementation support

Implementation Support

• Approach 1: Helping care providers to help themselves – develop best practice guidance tools and template. This is a light-touch approach for those who are nearly there. They are working with NCF to run focus groups. There is also buying guidance, tools and templates around information governance. There are also care provider masterclasses that offer support with building business cases and analysis – the Hubble project is important for this.
• Approach 2: Helping care providers to help each other – Providers want to hear from each other. Providers can speak to other care providers who are going through these journeys and who are providing support. It will include recruiting change champions who can be ambassadors for this work.
• Approach 3: Helping local systems to drive adoption – working with ICSs to build a stronger evidence base for the benefits of digital social care records. As a benefit of doing this, they will be providing a hands-on implementation.

Discussion:

• They need to look at what the digital care records look like across the whole sector.
• There are further questions including how they service the SME sector?
• It will benefit us all in the future to have full access to resources – we need to make it as easy as possible to use it.
• There are issues around the use of the data. Providers having to take on another full-time person to do digital input.
• SME’s may struggle to finance the investment with the best will in the world – they do not have the same resources and HR departments as larger providers
• Will this be a regulatory requirement to use digital social care record? Not at this stage.

Health and Social Care Equality Objectives – Helen Ketcher

• The CQC have a legal duty to set equality objectives every four years. They want to make sure that the objectives that they set align well with their future strategy.
• They have had feedback from over 5,000 people including different equality groups.
• Strong focus on using data and evidence and different levers to improve equality – using different parts of their powers and their influence

Discussion:

• Concerns were raised around the focus of people and how to ensure balance. The focus may discourage good examples. Instead of a focus on negative language, we need to celebrate success and allow people to access data so that they know what good looks like to improve their own settings.
• Bad data, badly interpreted will not be helpful. There can sometimes seem to be a stress on the poor quality, with no balancing emphasis on the good, or the hard work behind. Questions were raised about how we can challenge the data.

Operational Update with Q&A– Alison Murray

• There are useful headline numbers. The IPC tool is being used on all inspections. There is a new question around visiting – whether the care home is adhering to the government advice around IPC
• They are adapting the tool for supported living and extra care setting. Work is going slower than expected. They would like to share this information around this to this meeting

Designated settings

• The numbers of designated settings are reducing as demand reduces. Modelling from SPI-M suggests that demand will reduce in summer but will increase in autumn. DHSC considering what should happen to designated settings going forward; policy intent remains – the 14-day isolation for COVID positive remains but not sure how it will work.
• NOTE: HMT extended indemnity scheme funding up till the end of June
• They are still prioritising any new designated settings if they are coming through. There are 144 designated settings; reviewed 68%. 16% are in progress and have had a light touch review – no concerns have been raised and there are some lovely examples of good practice.

COVID positive staff working

• This is still causing some noise; cases have been raised with them and the CQC is looking at the details. There is pressure on the CQC to react in a certain way if notified of COVID positive staff. They cannot do this as every situation from providers had varied – all very different and all need to be handled appropriately.
• The DEVON case: unfortunate – police put out comms to say there was a joint investigation; CQC are doing their response; police doing theirs – not a joint investigation. The CQC’s approach to enforcement has not changed.
• NOTE: Location level death data – continue to receive FOIs on this; continuing to resist these; been reported to the ICO around this. Will keep us posted if they do have to release it.

Visiting bans

• They are looking at this issue. They have added a question to the IPC tool to address this. 25 complaints so far – found that either a mistake or due to outbreak.
• They love our NCF work on this and are sharing resources with inspectors.

LFT Testing for Inspectors

• LFT testing for inspectors – all of the inspectors have a supply of lateral flow. They will take lateral flow on the morning of inspection and they will be photographing the result. They also have weekly PCR tests. They will be able to show this photo to the homes and it is also a way to show if the 90-day testing rule

Mandatory vaccinations for care workers – they are keen for views

Inspection Priorities

• Provider bulletin is the last bulletin until the end of the pre-election period – 1st April till 7th May
• Continuing to inspect to create capacity or respond to risk
• Continuing to use the IPC tool in all care homes to help ensure and assess that people are achieving safe care
• Inspecting and rating processes – if all of the local intelligence suggests that a service has improved, then they will reinspect
• Continue with supportive work, ad hoc concerns by the public or whistle-blowers
• As well as doing IPC inspections and risk-based inspections and designated settings inspections, will also inspect and re-rate where appropriate to add capacity to the system
• 3 buckets of inspections: Supportive work; reactive work and risk drive work. They are committed to a minimum of 600 ASC inspections a month going forward – they have been doing more than that. They are not committing to a type of inspection; just whatever tool is important. One of the tools is IPC tool assurance inspections.

CQC Engagement insight – Latoya Tawodzera

NOTE for members: the CQC want us to bring insight and feedback on these issues at each meeting. Please send queries to the provider engagement email/ team so they can coordinate.

They want feedback on three areas:

1. Sentiment towards the CQC’s Approach

2. What are the current barriers to receiving and delivering good care?

3. What are the current issues having an impact on health and social care?

If you have any queries or suggestions for the next meeting, please contact Liz Jones by email: liz.jones@nationalcareforum.org.uk.