Since the 1 May when details of the Emergency Support Framework (“ESF”) were first published, the CQC has been hosting a series of webinars to further explain to Providers what the Framework is and how it will work in practice.
This article summarises some of the main points raised and aims to give Providers some insight into what they can expect from the ESF.
What is the ESF?
Broadly speaking the CQC say that the ESF is a process to help them, and others, understand the impact of what is happening during the current COVID-19 situation on service users, the care workforce and on Providers ability to be able to deliver care.
It essentially involves a Q & A type telephone call between the Inspector and Registered Manager, focused on how the service is coping in the pandemic. CQC will use the answers to the questions, alongside other sources of wider intelligence, to ascertain whether a service is “managing” or “needs support”.
The telephone call will be arranged at a time to be mutually agreed between the Provider and the Inspector. Where possible CQC will endeavour to ensure that the call will be with the “regular Inspector” of the service though they have highlighted that this will not always be possible.
The call has been billed as a “supportive conversation” with a focus on four main areas:
- Safe care and treatment;
- Staffing arrangements;
- Protection from abuse; and
- Assurance processes, monitoring & risk management
Unfortunately, CQC have not published the specific questions to be asked and it appears that these will not be provided in advance of the call which is a shame as it would be helpful to assist Providers to properly prepare for these calls at a time when they are already extremely stretched.
CQC have suggested that the areas they will look at could include:
- Infection prevention and control;
- Access to PPE;
- Environmental safety for residents, staff and visitors;
- Management of medicines;
- Risk management;
- Staffing arrangements; and
- Protecting people from abuse.
CQC maintain that the call will be a “two way conversation” and that they want to hear about Providers experiences and have a genuinely supportive conversation.
Most importantly CQC maintain that the calls are not an inspection, or a regulatory process and that they will not be used to rate a Providers performance. However, it is not clear how CQC can maintain that are not a regulatory process since, as set out further below they could ultimately lead to regulatory action. Providers should therefore take these calls seriously and ensure they are appropriately prepared for them.
The Summary Record
The Inspector will be making a note of the answers to the questions and a record of the discussion will be issued to the Registered Manager and Nominated Individual in the form of a PDF “Summary Record”. There appears to be no process for Providers to challenge the accuracy of that record. This is concerning since CQC say they will use “standard wording that reflects your answers to questions”. Providers who are not happy that the summary record does not reflect their concerns should not hesitate to respond to the CQC by email to set that on record.
The summary record will also include a summary of specific internal and external risks and challenges including good practice or innovative ways of responding to challenges and any sources of support that might have been suggested.
CQC have confirmed that they will not share the summary record with Commissioners and Local Authorities and it will not be published on their website. However, they may share information more generally such as trends and themes with relevant stakeholders.
The Outcome of the Call
CQC have said that the information from the calls will be used to form a view as to whether a service is:
- Managing; or
- needs support
If CQC have concerns they will either: provide additional sources of support; arrange a follow up call or carefully assess regulatory action through use of inspection and enforcement processes. This does therefore appear contradictory to the mantra that the ESF is not a regulatory process.
Can the ESF prompt an inspection?
It has been acknowledged that routine inspections remain suspended in light of the pandemic. In terms of inspections arising out of the ESF conversations, CQC have said they might inspect for four primary reasons:
- they believe there is evidence of abuse;
- there is evidence of a breach of human rights;
- there is evidence of neglect; or
- they are concerned about standards of care and treatment.
However, CQC has stressed that , before moving to an inspection, they would be looking first and foremost to do everything they can to obtain the assurances they need from intelligence they already hold; from the ESF conversations or from asking the provider to send information.
Any proposed inspection in the current climate would need to be considered as part of a management review process and would have to be signed off at a high level within CQC, most likely by Deputy Chief Inspectors.
If an inspection was to take place, it would be a targeted inspection which would only be looking at the concerns that have arisen through the ESF and would be a completely different inspection than an inspection that previously rated a service.
Call Frequency & Priority
There is no set frequency for the ESF calls and CQC say they will aim to be flexible.
Not everyone will receive a call. CQC will use its intelligence information to prioritise contact to the services it deems to be most at risk. That intelligence information will include includes things like statutory notifications, safeguarding information and concerns from the public/ people using services as well as new data sources such as the Residential and Nursing Homes NHS capacity tracker and the Homecare providers “update CQC on the impact of COVID-19” online form CQC’s website states that “If the inspector is confident that there is a lower risk level, they can decide not to call you…”
CQC have however said that, as they continue to monitor and engage, services with a higher risk level will have more contact from their inspector and will continue to do so until the emergency period is over. Therefore, some Providers can expect to receive more regular calls.
Like almost everything for the sector at the moment, this is a new and evolving process. As such, CQC say that will constantly update its guidance and recognise that this is a system that will develop evolve and grow.
However, in light of the possibility of regulatory and enforcement action arising out of the ESF calls, Providers should take them seriously, prepare for them, respond to any inaccuracies in the Summary Record in writing and provide any further information requested by CQC promptly.
My colleague Caroline Barker has previously provided some commentary on the ESF in a recent article on our website.
Providers with specific question are welcome to contact us or to join our free weekly online Provider surgery where they can also share experiences with other Providers. For more details of the free surgery that takes place every Wednesday at 11:30am, email email@example.com.