The CQC has published its third Insight report COVID-19 INSIGHT: Issue 3 . The report explores three main themes:
- The need for providers and other organisations to collaborate to tackle COVID-19
- Concerns that have prompted the CQC to inspect in recent months
- Challenges that providers have faced in caring for people detained under the Mental Health Act or subject to a deprivation of liberty
The report is split into six sections:
- Better care through collaboration
- Responding to feedback about care services
- Financial viability and stability in the adult social care sector
- The impact of COVID-19 on the use of Deprivation of Liberty Safeguards
- Protecting people’s rights under the Mental Health Act
- Our Data
Better Care through Collaboration
Collaboration has been a positive by-product of COVID-19. This increase in collaboration will be the subject of series of rapid reviews by the CQC over the next two months in a project titled Provider Collaboration Reviews (PCRs). The reviews follow the CQC’s earlier Beyond Barriers report which noted that health and care services can achieve better outcomes for people when they work together, something which is even more crucial during times of crisis.
The PCRs will focus on Integrated Care Systems (ICS) and Sustainability and Transformation Partnership (STP) areas. The aim of the PCRs is to evaluate how providers are working collaboratively in response to the coronavirus pandemic, support providers across the sectors by sharing learning, ultimately to drive improvements and prepare for future pressures on local health and care systems.
The CQC will use data it holds to undertake conversations with providers and ICS and STP leaders as well as to look at the experiences of people who use services. The first phase of review, will focus on the interface between health and adult social care for the over-65 population group and will take place in:
- Bedfordshire, Luton and Milton Keynes ICS
- Norfolk and Waveney STP
- The Black Country and West Birmingham STP
- Lincolnshire STP
- North East and North Cumbria ICS
- Healthier Lancashire and South Cumbria ICS
- Frimley Health and Care ICS
- Sussex Health and Care Partnership ICS
- North West London STP
- One Gloucestershire ICS
- Devon STP
The Insight report highlights some of the key factors of collaboration such as agreed vision, local agreements, shared governance arrangements as well as strategies for sharing and redeploying staff. The report notes that providers are keen to continue this collaboration, seeing it as an opportunity to resolve pre-existing problems and to work together across different pathways and services.
Responding to feedback about care services
The Insight features a recent campaign Because We All Care being led by CQC and Healthwatch England in response to COVID-19. The campaign aims to encourage more people to share their experiences of care to help the NHS and social care services identify and address quality issues and provide the best care possible.
Impact on financial viability during the pandemic
The financial strain on adult social care providers is given a mention, echoing concerns of the Association of Directors of Adult Social Services in their Coronavirus Survey, published last month. The survey revealed that a quarter of directors have concerns about the financial sustainability of most of their residential and nursing providers since the outbreak, and 15% of directors had concerns about the financial sustainability of most of their homecare and community care providers, whereas the figure was only 3% before the onset of COVID-19.
The CQC draws a comparison to its own recent analysis of providers through its Market Oversight scheme showing an overall reduction in admissions to care homes during the pandemic. Its analysis shows that self-funded admissions have decreased in comparison to local authority funded admissions, therefore putting added financial pressure on homes that are more reliant on people who fund their own care.
The impact of COVID-19 on the use of DoLS
All providers must notify CQC about the outcome of an application to deprive a person of their liberty. However, the CQC has seen a sharp fall in the number of notifications between March and May compared with the same period in 2019 (a reduction by almost a third (31%)).
Furthermore, CQC inspectors have seen a shift in providers focus away from DoLS and towards the introduction of the Liberty Protection Safeguards (LPS). The report highlights that the delay and uncertainty around the introduction of LPS and the existing poor understanding of DoLS is increasing the risk of people being deprived of their liberty without the proper authorisation.
Protecting people’s rights under the Mental Health Act
The Insight report reminds us that the CQC has a duty under the Mental Health Act 1983 (MHA) to monitor how services exercise their powers and discharge their duties when people are detained in hospital or are subject to community treatment orders or guardianship. To do this, since 8 April the CQC has been using a new remote method of monitoring individual mental health wards. This has included collecting data from patients, families and carers via phone, email or video calls to identify, support or seek response to the new challenges impacting patients, such as visits by families and carers, blanket restrictions and decision making. This work is linked to the CQC’s continued focus on risks of closed cultures.