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By Debbie le Quesne

Archive for the ‘new cqc inspections’ Category

Government spending review may offer hope to social care

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A critical spending review to determine medium term plans for Governments department will provide a platform for ADASS to air its concerns over funding for social care.

The review has to take place this summer because there are no detailed spending plans in place for the next financial year. Already private discussions are taking place and ADDAS is feeding the key issues into the agenda.

Quoting John Jackson, co-chair of Resources Network, the outcomes of the review could be:

  • Health and social care will be seen as a single entity
  • This will provide some protection for adult social care (but remember that health is not being funded to meet increased demands)
  • It will be accompanied by a requirement to pool budgets (probably under the control of Health and Wellbeing Boards)

So what are the implications for local government? Here are Mr Jackson’s thoughts:

Any new government or ministers will want to pursue eye catching ideas – some of them will be good (e.g. Health and Wellbeing Boards) but others not and will lead to considerable change at a time when systems are under huge pressures

Sadly, he predicts that some local authorities (and some local health and care systems) are under significant risk of falling apart in the next two years. Oh, yes!

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Duty of candour – exploring the real cost of legalities

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Duty of candour – exploring the real cost of legalities

Like all computer users, the Google search engine is never far away from my fingertips, but I was amazed at the rash of links I found when I typed “CQC duty of candour.”

Page after page popped up – mostly because of some comprehensive work by the Commission search engine optimisation techy geeks. Clearly this is something CQC is going big about.

But these top of the pile listings were followed by law firm information articles, sinking in legal jargon and promoting their compliance services to avoid big trouble.

Some care observers branded the new regulation, introduced as ‘live’ at the start of the month, as “the rebirth of the CQC.” Indeed, the Health & Social Care Act 2008 (Regulated Activities) Regulations 2014 makes important changes to health and social care standards which now being regulated with fresh zeal.

They represent one of the main ways in which the Government is responding to the Francis Inquiry that recommended the enforcement of fundamental standards to prevent problems like those at Mid Staffordshire, Winterbourne View and elsewhere.

Lets get legal (promise I’ll be short): The new Fundamental Standards of Care replace the 2010 regulations and are a response to the Second Francis Report into events at Mid Staffordshire.

Whilst the 2014 regs cover, in broad terms, the same subject matter as those dealt with under the 2010 regulations, the ‘Standards’ are now much more focused, the language is more direct and they set out clearly the higher bars which all health and social care providers must adhere. This dovetails with the requirement in the newly- enacted Health and Social Care (Quality and Safety) Act 2015 which “will in the future require the Secretary of State to make any regulations considered necessary to secure that services cause no avoidable harm to those that use them.”

As part of that raft of change, the new duty of candour has been implemented. This provides that where a notifiable safety incident – basically those that cause harm –occurs within a service, there are certain notification requirements which must be followed.

Already emerging is confusion over the definition of ‘a notifiable safety incident’ and it’s critical all care workers are up to speed with this knowledge.

Under the Health and Social Care Act 2008 (Regulated Activities)(Amendments) Regulations 2015 the definition of ‘harm’ for independent sector health and social care providers is as follows:

  • Death of the service user, where the death relates directly to the incident rather than to the natural course of the service user’s illness or underlying condition;
  • An impairment of the sensory, motor or intellectual functions of the service user which has lasted or is likely to last, for a continuous period of more than 28 days;
  • Changes to the structure of the service user’s body;
  • Prolonged pain or prolonged psychological harm;
  • The shortening of the life expectancy of the service user;
OR
  • The service user requires treatment by a healthcare professional to prevent death or any of the above injuries.

Already the lawyers must be rubbing their hands at the potential money-spinning services they can offer providers to ensure the procedural steps in satisfying the duty, and evidencing it to demonstrate compliance, are in place.

It’s early days, but the impact of this new legal duty already appears to be looming as an extra training cost for managers and their staff. Who could possibly afford the consequence of getting this wrong?

Checklist: Having defined the notifiable incident, care providers must:

  1. Notify, and support, the relevant person as soon as reasonably practicable after becoming aware of a notifiable safety incident
  2. Provide an account of the incident as known at the time
  3. Advise what further enquiries the provider will be taking
  4. Offer an apology
  5. Follow up the above in writing, and provide an update on the enquiries
  6. Keep a written record of all communications

Guess WMCA will be running courses soon, but I promise we will do all we can in out bi-monthly member’s meetings so that no extra cost of taking people away from the workplace will be incurred.

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