Most will look back on 2012 with fond nostalgia but it is hard to remember a more challenging time in the health and social care sector. Whilst the rest of the nation revelled in a landmark year filled with enormous sporting achievement, a very special milestone for the Queen and news of a royal baby, the health and social care sector found little to celebrate. A hostile financial climate, continued sector-wide stigma from the Winterbourne View scandal and an increasingly aggressive approach by the CQC meant that delivering care was becoming more difficult than ever.
In November 2012 CQC announced in their State of Care Report for 2011/2012 that its inspectors had seen “examples of providers who struggle to cope and fail to deliver the quality of care that people have a right to expect”. The report identifies the difficulty of an ageing population and their increasingly complex needs (specifically dementia) coupled with the need for businesses to employ sufficiently skilled staff, as one of the main difficulties faced by providers. CQC warned that they “will not leave poor care unchallenged. We will follow it through with further inspection and enforcement activity.”
CQC are keen to demonstrate that they are an effective regulator after the government described it as having a “long way to go” in front of the Public Accounts Committee last spring. This impression does not appear to have improved as the House of Commons’ Health Select Committee suggested that inspections needed to be much more challenging in its report released at the beginning of 2013.
CQC will take this feedback as a licence to intensify inspections and to continue to ensure that all enforcement action is publicised. They have a point to prove. It has never been more important for providers to take a step back from their service and reflect on the care that service users are receiving. There is great value in thorough, internal audits, particularly in respect of the Outcomes that directly affect service users with more complex needs. For example, how could you prove to a CQC inspector that your service is meeting Outcome 1 (Respecting and involving people who use services)? How do you ensure that your service users with dementia express their views, fully understand their treatment and have their dignity and independence respected? A number of providers that I have encountered would answer that of course these aspects of care are met and are obviously the basic foundations of providing care; however, in the eyes of CQC it is not enough to simply say that a service is compliant; a provider has to be able to prove it. Providers should be fully aware of the importance of documentary evidence.
Approach your service with a critical eye, measuring your compliance with each Outcome against the “Essential standards of quality and safety”. Engage with service users and their families about the service that they receive and take positive steps to act on this feedback (all of which should be evidenced of course!). Service users with dementia who lack capacity should be introduced to independent advocates who can assist them with decisions that will affect their care and will provide an impartial view.
Providers should also be mindful of the specialist skills required of their staff when caring for service users with dementia. Staff should be aware of how practices should be adapted to meet the care requirements of those service users with more complex needs. Evidencing that staff have such skills is important in proving to CQC that care is tailored to the needs of the individual.
Where there are weaknesses in your service take robust and sustainable steps to improve before CQC intervene. Know that CQC are honing in on how service users with the most complex needs are cared for and are looking to create headlines that show they can be tough on providers. Don’t let your service be the victim of CQC’s quest to make an example of bad providers. If you are proud of the great care you provide, think about how you will prove it when the inspector calls.