New Framework, New Era? CQC Changes Explained
Helen Fuller,
Managing Director & Founder of Care 4 Quality considers how the new CQC
Single Assessment Framework will impact your Care Home
Overview
The Care Quality Commission (CQC) announced a new strategy which will
bring all health and social care providers under one single framework to
provide more consistency across services.
As such, care providers will be expected to implement certain changes in the context of CQC’s four new areas of focus, as outlined in its publication ‘A new strategy for the changing world of health and socialcare’
·
People and communities:
Regulation that’s driven by people’s needs and experiences, focusing on what’s
important to people and communities when they access, use and move between
services.
·
Smarter regulation: Smarter,
more dynamic and flexible regulation that provides up-to-date and high-quality
information and ratings, easier ways of working with us and a more
proportionate response.
·
Safety through learning:
Regulating for stronger safety cultures across health and care, prioritising
learning and improvement and collaborating to value everyone’s perspectives.
·
Accelerating improvement: Enabling
health and care services and local systems to access support to help improve
the quality of care where it’s needed most.
Inspection format
The current timetable of on-site inspections will be replaced by frequent monitoring and engagement calls to assess risk.
These are known as Direct Monitoring Activity (DMA) calls.
These phone calls are based on a set of questions with a focus around the key lines of enquiry (KLOEs).
Questions
will be asked around:
·
The continued relevance of the registered
service user bands, checking that the service is providing the regulated
activity appropriately.
·
Mental Capacity Act (MCA), consent, best interests
and Liberty Protection Safeguards.
·
Risk management and safeguarding people.
·
Care planning.
·
Safe staffing.
·
Medication.
·
Infection control.
·
Activities and lifestyle choices.
·
Stakeholder feedback.
·
Governance and provider oversight.
Inspectors will also ask service-specific questions around any
other intelligence that they have received from third parties, such as the local
authority.
CQC will inform you of the outcomes of the call. If your service
is identified as ‘very high risk’, you will receive further engagement calls
and can also expect on-site inspection activity.
Key lines of enquiry
The current service frameworks will be replaced by a single
framework, which will be used across all providers from initial registration
application. The aim is to simplify the process and provide a coherent and
joined-up service history.
The key questions will remain, but the KLOEs will be
replaced by ‘I’ statements. This will help the regulation to be driven
by people’s needs and their experiences of the health and care service.
These ‘I’ statements will be underpinned by ‘We’
statements. These statements outline the expectations of how providers are
meeting the ‘I’ statements. They are quality indicators and there will be
between four and 10 ‘We’ statements beneath each ‘I’ statement.
Evidence will then be reviewed under one of six to ascertain if
the quality statements are being met.
Ratings
There will be no change to the current rating categories; however,
there is the possibility of CQC having the ability to change a service’s rating
without an on-site inspection, based on the findings and information gathered
during a remote monitoring call.
Partnerships
There will be increased focus on information gathering from care
providers’ partners and stakeholders and you may be asked for contact details
of relatives and staff as part of the remote monitoring process.
Evidence categories
The evidence categories recently went to consultation, and it is
proposed that each service type will be asked to provide a list of evidence
under each of the five key questions and topics (Safe, Effective, Caring,
Responsive and Well-led).
Evidence will fall under one of six categories:
1.
People’s experiences.
2.
Feedback from staff and leaders.
3.
Feedback from partner organisations and stakeholders.
4.
Observations.
5.
Processes.
6.
Outcomes.
A score will be made against each of the six evidence categories, which
will then be calculated and will determine a rating for the care service.
What
can care home providers do to prepare?
1. Work with
your care team and staff. Share information about the strategy with them
as it becomes available. Add it as an item to your team meeting agendas, share
the CQC resources with them, and make quality and compliance a cultural value in
your care facility.
2. Join CQC’s
Citizen Lab. This
gives you the opportunity to have early access to what CQC is thinking, as well
as share your opinion on the upcoming changes.
3. Keep your
CQC presentation/Personal Information Record up to date. This will save you
time in the long run as it will be requested!
4. Look at
the DMA questions for care providers. Start to gather evidence and write your
answers before the call.
5. Keep a
record of innovation and creativity within your care service. Make sure you can
evidence the impact on people and the wider facility.
6. Reach out
to other services. Are you part of leadership forums and healthcare groups in
your area? Networking and sharing information and best practices helps to drive
innovation and improvement across services.
7. Make sure
your audits are up to date and clearly reflect any changes made/actions taken
in response to audit findings.
8. Survey
people who use your service, including friends, family and visiting
professionals – how do you utilise this feedback?
9. Treat
external stakeholders and the local authority in the same way as you do the CQC
– they will be asked for feedback.
10. Ensure
your evidence is well organised. Think about the new evidence categories and how
you will present this to CQC.
11. Consider
implementing a compliance software system. Electronic systems and processes can
save a significant amount of time.
12. Involve
people who use your service and their families as much as possible in your
service’s development. Consider asking people who use services to join
interview panels.
13. Remember,
CQC is looking at how care providers work together within systems to help
achieve shared care goals, so:
·
Increase your understanding and awareness of the
care system you belong to.
·
Identify local healthcare themes and trends.
·
Consider the pressure points in secondary care – is
there any way you can support with this?
·
Look out for any initiatives in your area with
which you could join forces to support the ongoing national aims of reduction
in health inequalities, reducing hospital admissions due to Urinary Tract
Infection, and early detection of pressure damage which could lead to tissue
breakdown.
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