Cutting Corners to combat a crisis– what will the long term effects of the COVID-19 pandemic be on the health and social care sector?

With the speed at which this global pandemic is developing, is it accepted that corners will be cut in the health and social care sector and the slack will be picked up at some point in the future? And if so, does the Care Quality Commission have the same view?

On 16 March 2020, the Care Quality Commission (CQC) announced that they had suspended all routine inspections until further notice. Instead the CQC will be responding to specific risks, such as whistleblowing and safeguarding issues. This risk based approach to inspection will mean a more focused and targeted approach with an increased use of technology and desktop monitoring. The CQC’s March Board meeting highlighted that during this period, services will not be rated and the sector will not see enforcement of the routine sort. We are to expect enforcement action when there is an extreme risk.

Whilst the CQC recognises that we are in extraordinary times, they have maintained that they have a duty to service users and as such, still need to protect the interests of those people. This means that while routine inspections have stopped, regulation has not. Simply put, regulation will take a different form. The CQC is of the view that it still has a critical role to play and it will work in different ways to ensure the safety of people using services is maintained.

Ridouts feels it has a duty to warn the sector that suspension of inspections does not mean standards will be allowed to deteriorate. There are areas of service that will inevitably be affected by this pandemic. However, the regulation of such areas has not been diluted or watered down, merely monitored in a different way.

It has come to light that, in the health sector a deal has been struck with the nursing and medical unions to relax staffing ratios for critical care. The normal ratio is one specialist nurse per patient; this has been relaxed to one specialist nurse per six patients, with the specialist nurse being supported by a team of non-specialists. Similarly, the normal ratio is one Intensivist Consultant per 8 to 15 patients; this has been relaxed to one consultant per 30 patients, and the consultant supported by non-specialists. This relaxation will enable the NHS to staff extra wards that will be created to deal with Covid-19, particularly in London. Union leaders would not normally agree to such relaxations, however both nursing and medical unions have agreed that this is necessary in this time.

The CQC has not provided any specific guidance on staffing levels/ratios in the social care sector for this difficult period. Kate Terroni, Chief Inspector of Adult Social Care has said that it is “unlikely we will be able to issue one-size-fits all advice… We never advise on absolute staffing numbers in any sector…”

Understandably the CQC cannot relax its regulations, which are set out under the Health and Social Care Act 2008. This means that requirements, such as notifications to the CQC have not changed and for example, a service would still be required to notify the CQC in the usual way if a registered manager is absent for 28 days or more because of Covid-19, as well as to set out the steps the service is taking to make sure adequate management cover and safe systems of care are in place.

There is talk in the sector of staff receiving upskilling training to become an extra pair of hands in other areas. The CQC recognises that during this period services’ priority is to provide care to people, which may result in staff training being delayed. Nevertheless, services must still ensure that staff are competent, skilled and confident in providing safe care to service users and therefore training, whether it is core/mandatory training or upskilling will most likely still need to be undertaken.

A prime example is the delegation of medicine administration. A registered nurse can delegate to a care worker the administration of medicines, that are not routinely administered by a care worker, such as insulin. However, as the registered nurse is accountable for their decision to delegate the task, they must only delegate tasks that the care worker is appropriately trained and competent to carry out. Therefore the care worker will need extra and more specific training and competency checks before undertaking non-routine medicine administration.

The charity, Skills for Care has recently issued guidance instructing Adult Social Care providers to use digital rather than face to face training during this time. Whilst digital training might not be appropriate in all circumstances, this is welcomed guidance when the sector is having to make difficult decisions when it comes to deployment of staff at a time when staffing levels are likely to be low.

Services can recruit volunteers (including family members) during this period. It is for the service to assess each situation and match volunteers with activities that suit their skills. Background checks, relevant training and supervision must be undertaken to ensure service user safety. The CQC have produced guidance to address emergency situations where services need to deploy staff and volunteers on just an adult first check, which is usually returned very quickly.

The CQC understands that services will need to be flexible, such as working collaboratively with other Providers in response to Covid-19. The CQC supports partnership working whereby services share staff such as nurses with other services, provided staff are fit, proper and competent.

Providers are not only struggling with staff numbers but also staff protection. The CQC has a role to play to not only ensure the safety of people using services but also those that deliver those services. It has been argued that the same promises given to NHS hospital staff should be given to social care staff in relation to Personal Protective Equipment (PPE). As described by Kate Terroni the health sector and social care sector are “two halves of the same whole”. Therefore, it is pleasing to see that the Department of Health and Social Care has confirmed that free distribution of fluid repellant face masks has started and that every care home will receive at least 300 facemasks. There is a dedicated line for the health a social care sector to obtain PPE on 0800 915 9964 and supplydisruptionservice@nhsbsa.nhs.uk. There is also PPE Dedicated Supply Channel which is a parallel supply chain to the normal NHS Supply Chain service that has been set up to meet urgent volume requirements for core PPE items contactable on 0800 876 6802.

To answer the question, corners cannot be cut when it comes to the provision of care and services in the health and social care sector as a result of Covid-19. The CQC have promised to apply the regulatory standards proportionately during this difficult time and to consider the burden on Providers of Covid-19. They are also saying that they are willing to support and work with Providers during these unprecedented times; with Providers being encouraged to pick up the phone to their local inspector as the CQC are willing to listen.

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