By Debbie le Quesne

Archive for October 2014

CQC new regime: The good, the bad and the ugly

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First the good news: The Care Quality Commission has found “many examples of good and outstanding care” using their new inspection criteria.

And now the bad: As the expert-led inspection model rolls out the regulator is discovering wide and “unacceptable” variations in quality.

The tougher approach also discovered that there are not just big differences in the quality of care that people experience from different providers, in different places but also sometimes at different times of the day or day of the week.

The five-question approach – are they safe, are they effective, are they caring, are they responsive to people’s needs and are they well led? – is bound to bring change to existing ratings and perhaps the findings with a sample of NHS trusts will be mirrored in our care and nursing homes.

In an article on the CQC website, the regulatory body says: “We began applying our new inspection approach to NHS trusts in September 2013. We’ve seen some outstanding care – but we’ve also seen examples of care that requires improvement or that’s inadequate. We have found differences in quality from one trust to another, from hospital to hospital within trusts, and between different services within hospitals.”

Some 38 NHS acute trusts were checked by the end of August 2014; nine achieved an overall rating of good, 24 were rated requires improvement and five trusts were rated inadequate.

Stating the obvious, CQC says good leadership drives up quality and safety overall.

But as CQC “calls time” on unacceptable variation in the quality of care and higher the bar for providers, my fear that you get what you pay for remains.

Indeed, I cannot think of a single WMCA member who does not want excellence in their service, but how, tell me how, are we supposed to achieve such glorious goals when there’s such a tight hold on local authority purse strings for bed purchases?

I applaud the sentiment of the Commission to empower consumers to use CQC’s inspection reports and ratings to make decisions on care choice. I also believe in their advice that “providers of poor care need to look at those who are doing it well and learn from them.”

Quality, however, always has a cost – an ugly word, I know – and I’m let pondering once again where the finance will come from to meet the new CQC inspection challenges

Don’t miss out on our audit tool for the new CQC inspections

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The new Care Quality Commission inspection model has been rolled out and we’re all eagerly waiting for the new ratings to be announced.

At the time of writing this, nothing has been announced among our members so we don’t really know how high the bar has been set against the previous criteria.

We are, however, confident that delivering a practical guide which can easily be personalised to any care business, will be an invaluable asset for members in this time of transition.

Simply, we want to make sure everyone is well prepared for the inspection revisions, so West Midlands Care Association has produced a simple, walk-through guide that addresses the five critical pillars of the new regulations.

It’s aim is to provide an easy-access knowledge base of how to safely justify answers CQC is looking for and ensure nothing is missed.

Those using the tool and unable to resolve queries will be able to access support with a phone call.

Under the CQC initiative, inspectors will use professional judgment, objective measures and evidence to assess services against five key questions: Are they safe; are they effective; are they caring; are they responsive to people’s needs; and are they well led.

A standard set of key lines of enquiry (KLOEs) will be used to extract the information to ensure a level playing field on all inspections, a move that has been welcomed by the industry.

We all know the new approach is all about CQC asking the questions that matter to the people who are using the services, but there is a raft of critical procedures and policies that care providers need to be getting right.

Just having the knowledge where to look for supporting information required by CQC and how to present it will make a huge difference to inspection outcomes.

The inspection process aims to provide good information for the Commission for ratings and give the provider a snapshot of how they can improve.

Our CQC Audit Tool looks at ways of avoiding the pitfalls and ensuring nothing is missed in the way CQC expects the management of care to be delivered. It’s simple to use and everything is made as clear as possible

For non-members, the digital document available through email, is £70 and for member £35. Those who have previously purchased audit inspection tools

Dementia headlines: So what about all of the good work?

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Headlines claiming that there is a national care betrayal of those suffering with dementia have invaded our living rooms once again.

A Care Quality Commission review found widespread neglect, lack of care, poor training and failings in communications. And that may well be the case.

Most of the 4,000 elderly in UK care homes suffer with degrees of dementia and the CQC found that despite the scale of the problem, professionals’ responses were not adequate. These facts too, though disappointing, don’t get my blood boiling.

But the fact the findings were presented by the media as a national scandal tarred every region with the same brush.

How could you possibly say, for instance, my home town of Dudley with its Dementia Gateway initiative is failing? Then there’s Sandwell, where a care quality drive is hugely focused on the memory-loss condition . . . or Birmingham where home-owners are being given financial incentives to build with dementia in mind?

I’ll concede that nationally there are both good and bad examples of dementia care, but the way findings have been delivered are terribly one-sided.

We cannot deny we have a lot of work still to do and my association has a huge commitment to improving this specialised kind of care.

We are constantly working closely on training models with Professor Dawn Brooker of Worcester University, who established the Association for Dementia Studies (ADS) in 200; we are wholly committed to the Dudley Dementia Gateway project and support Sandwell in its endeavours too.

There is a huge amount of exemplary work in the Midlands which appears to have been overlooked.

Across the country there are huge disparities in funding allocations for dementia that could explain the flawed delivery of care.

In the affluent south there are reports of dementia care attracting local authority funding of £1,000-plus per week, while in the Midlands the average figure is £420.

Sadly there is no common national figure. Dudley pays an extra £14 a month for dementia care on top of its normal allocation for residential care; Sandwell gets £20 and Wolverhampton £29. As monthly figures they don’t even begin to scratch the surface of the additional costs dementia care demands.

Perhaps the real scandal here is with the Government that still has not grasped the nettle on how we are supposed to finance the care of these very needy people.

Why we should belong to the new Care Association Alliance

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The newly formed Care Association Alliance is now the biggest representative body for care providers in the country.

With more than 40 regional care association already signed up and others set to join, it already has already established a powerful lobbying voice within the first two months of its inaugural meeting.

Its aim is to represent, in a more defined and robust way, the issues that are perpetually raised at regional and local meetings by care providers.

Already in talks with lawyers over Judicial Reviews and their often-negative impact on care businesses and local authorities, the CAA is also trying to find a way ahead in the current nursing staff shortage.

A programme involving talks with CCGs, hospital trusts and social service departments is being rolled out over the next months. One area that is being researched is the role of advanced care practitioners in nursing homes and what most effective models of training could be developed or are available.

Current reports suggest up to 20,000 vacant nursing posts in the NHS alone and the expected demand for new nursing staff is rising by 6,00 nurses a year.

In a message to West Midlands Care Association members, this is what I have to say:

There has been a huge groundswell of support for the WMCA to join the Care Association Alliance. There are many regions why we should be part of this new, powerful, group of professionals.

Firstly, is affords local associations like ours a greater credibility to tackle many of the ongoing issues that have not been given an agenda by our national representatives. And let me add here that we are not in competition with them.

Indeed, we will do everything possible to work alongside existing umbrella bodies within the sector and preserve relationship with them. Our role will be different and our agendas too. Essentially, we are campaigning on more regional issues; issues that are often at the sharp end of care delivery.

Currently we’re looking at the issues of the nursing shortage and the corrosive Judicial Reviews that have dogged our sector in recent times.

Sadly, size does matter. It allows, for instance, our regional association to punch above its weight. It gives us access to decision-makers, it enables us to have a huge knowledge-base of best practice, it helps members deliver their own regional problems to national ears in the knowledge that some 42 associations are standing with them to forge change, and in its ranks has some great minds to help solve problems.

We cannot afford not to be part of this exciting development in not only shaping the future of care, but doing it in a way that supports business models rather than undermine them.