Lisa Lenton, ARC England Director, attended the CQC Trade Association meeting on 14th September. The key points are summarised below for your reference:

Ratings – there has been a minimal change overall in Adult Social Care ratings. The shift is continues to be a positive one with improvements across the board. Some details listed below:

The current overall ratings by service type were presented up to 8th September 2016.

Overall ratings Adult Social Care up to 8th September 2016

  • 2% Inadequate
  • 25% Requires improvement
  • 72% Good
  • 1% Outstanding

Community social care ratings:

  • 1% Inadequate
  • 15% Requires improvement
  • 82% Good
  • 2% Outstanding.

The least well performing continues to be Nursing homes (4% Inadequate, 36% Requires Improvement, 60% Good, 1% Outstanding).

Unfortunately, no up to date data in respect of Learning disability services specially was available this month. We were advised that the figures given at the previous couple of meetings was not to be a regular reporting stream however, following discussion it was agreed that this will be produced for us on a quarterly basis.

There was a discussion regarding the information given on ‘overall ratings by region’. It highlights the ‘worst’ rated services are in the North West and in the South East. CQC is undertaking work to understand the drivers of why there is disparity across regions. A few suggestions were lower CQC staffing levels (and so not as many services have been inspected – and they focus on the ‘risky’ services first), commissioning practices, the market make up (self-funders v. LA’s), and funding. This data is being shared with ADASS.

The ‘Outstanding tool’

Draft guidance has been designed to help both inspectors and providers to better understand what it takes to be ‘Outstanding’ for each of the 5 key questions. This was issued to Trade Associations prior to the meeting for comment. The draft guidance is to be shared with inspectors, providers, previously rated ‘outstanding’ providers and other stakeholders too. The comments made in the meeting were around looking at ensuring there is a wider range of settings included to give breadth to its relevance

Hospital discharge needs assessment  

An issue was raised regarding the requirements and regulations in terms of readmission of people into care homes following periods in hospital. There have been some concerns expressed care home providers will not readmit people without conducting a full, in person assessment. CQC draws provider’s attention to Regulation 9 of 2014 Regulated Activities Regulations.

In terms of carrying out a needs assessment for an existing service user: “…whilst needs assessments of people not previously admitted to a service will normally require face to face contact, where an existing service user has been admitted to hospital, regulation 9 does not necessarily require the provider to physically see the person when reviewing their needs and planning the re-start of their care on discharge.”

Every decision about a needs assessment requires a judgment – “The provider’s decision about this requires careful judgment and will need to take into account a variety of variables. They will need to be confident about:

  1. The reliability of the needs-related information supplied by other sources. (the key word is confident – it was stated providers may wish to make further assessments prior to readmission if they aren’t )
  2. Their ability to meet the person’s continuing and any new needs
  3. The person’s (of someone with valid legal powers’) continuing consent to the care they will provide.

Please refer to the current guidance for clarification on this situation.

Single shared view of quality

An update was given regarding the work CQC are undertaking with partners, providers and the public to agree a definition of quality and how this should be measured based on the five key questions. As well as working with partners in the NHS, NICE, Public Health England and Health Education England, social care trade association bodies are encouraged to contribute to the strategy. A specific Adult Social Care quality strategy will actually sit below this overarching strategy. Concern was raised that invitations for membership bodies to the ASC meeting in respect of this were very late coming out an therefore the representation from Social Care providers wasn’t as comprehensive as it should have been. Conversations regarding our role in this process are continuing.

Mental Health update

With a highly diverse and developing market and adapting to new models of care, work is continuing in respect of inspection of services that support people with mental health conditions, whether within the hospital, adult social care or primary medical services directorate.

CQC is looking at simplification of registration systems and queries, development of risk based registration, the role of relationship management, revision of approach to inspecting combined providers, enhancing inspector skills and knowledge about mental health to name a few.

Please remember, ARC England is there to represent you at the trade association meetings! We regularly attend, so do let us know of any inspection issues or concerns and we will feed these directly to the meetings and get back to you.