In April 2015 the new Regulated Activities Regulations came into force. Whilst the majority of the new Regulations mirror the old regulations to a certain extent, there have also been some significant changes to the law. One of these significant changes has been the inclusion of the new Regulation 9, person-centred care. Whilst this was implicit in the old regulations, person-centred care has now been placed at the forefront as its own regulation.
The impact of person-centred care being incorporated into the Regulations as its own regulation means that if CQC does not think that a provider is providing person-centred care as described in Regulation 9 then CQC can conclude that the provider is in breach of the Regulations. A breach of Regulation 9 can lead to a negative inspection report (any breach of the Regulations usually means that a provider cannot be rated higher than ‘Requires Improvement’ for the key question that the regulation relates to) or CQC taking enforcement action in line with its enforcement policy. Therefore it is important that all providers consider how they can ensure they provide, and can demonstrate that they provide, person-centred care to their service users.
Regulation 9 of the Health and Social Care Act (Regulated Activities) Regulations 2014 states that the care and treatment of service users must be appropriate, meet their needs and reflect their preferences. CQC states that providers must do everything reasonably practicable to make sure that this is achieved. The Regulation specifically lists certain steps that CQC expects providers to take to ensure that they provide person-centred care to their service users. In particular, the Regulation refers to:
· Carrying out an assessment of needs and preferences for care and treatment collaboratively.
This means that the service user and/or a person lawfully acting on their behalf, is involved in the assessment as much or as little as they wish. CQC expects to see assessments carried out upon engagement with the service user and also for regular reviews to take place. The level of involvement and reviews should be clearly recorded to demonstrate to CQC that this has been done.
· Designing care and treatment with a view to achieving service users’ preferences and ensuring their needs are met.
Providers should be able to show that they have taken all reasonable efforts to meet service users’ needs and preferences. In instances where their needs and preferences cannot be met CQC states that it expects the provider to have explained the impact of this to the service user and explored alternatives to enable the person to make an informed decision about their care and treatment. Clear care and treatment plans should be in place which detail ways in which the person can maintain their independence and include agreed goals.
· Enabling and supporting service users to make or participate in making decisions relating to their care or treatment to the maximum extent possible.
CQC states that providers must make all reasonable efforts to provide opportunities to involve service users in the decision making process. We have seen CQC raising this particularly in relation to service users with dementia. Providers must not assume that because a service user has dementia they are unable to make a decision. Appropriate steps should be taken to maximise a person’s capacity in different ways to make as many of their own choices as possible. Importantly, a record must be kept of decisions made by service users and/or those acting on their behalf. If there is no record of the decision making process then it will be difficult to prove to CQC that the provider took appropriate steps.
Whilst it is not explicitly mentioned in Regulation 9, we have also noted that CQC is picking up on the provision of person-centred activities and has stated some providers are in breach of the Regulation by virtue of not providing appropriate person-centred activities. Activities provided should be determined by service users’ life histories and personal preferences and providers should be able to demonstrate that appropriate activities are provided to service users.
CQC’s website provides a summary of each of the new Regulations including a list of resources that providers can refer to ensure compliance. Providers should review these resources as it is very likely that CQC inspectors will be having regard to such resources when carrying out inspections.