The Care Quality Commission (CQC) has just released the State of Health Care & Social Care in England for 2017/18. The report covers all aspects of care in England, comparing where we currently are and where we need to be.

In essence, the report outlines that generally the quality of care in England is good. However, it does acknowledge that the availability of good care is inconsistent. Meaning that the quality of care we receive is dependent on our geographical location within the country. It is recognising the gaps we receive in our services, in some cases resulting in some people not receiving the care they need. According to Age UK, approximately 1.4 million people in the UK do not have access to the care they need, that is a 20% increase in unmet care needs for older people alone!

Safety

The CQC highlight the safety of services in England has increased slightly, however it remains their biggest concern moving forward. Currently, one in five adult social care services requires improvement under the ‘safety’ KLoE. This is all well and good to show, however, what the CQC fail to outline is how they will support care providers moving forwards, to ensure the safety of care is continuously improving.

This again feeds in nicely with technology which we are about to discuss. But essentially, technology is ensuring we have more secure and accurate data than ever when it comes to the provision of care. With advances in eMAR & EMM technologies, the administration and management of medicines have never been as safe and highly monitored as it is today.

When looking at the breakdown of rating across the CQC’s KLoE’s, it is evident that safety is the biggest concern, with less than 0.5% of providers being rated outstanding in this segment.

CQC Improvement Ratings

Quality

A huge concern for the CQC is that not enough providers rated ‘requires improvement’ are increasing their quality of care. The figure below shows that 42% of providers rated ‘requires improvement’ in 2017 retained the same rating. The same measurement the previous year was only 36%. Even more alarmingly, 7% of these providers deteriorated from ‘requires improvement’ to ‘inadequate’. This certainly isn’t ideal, and more needs to be done by the relevant bodies to ensure that solid development plans are put in place for providers with these ratings, and are enforced. Not only do we need to ensure we are providing the best care possible, but people’s jobs are also on the line. Providers have been, and continue to be shut down, meaning carers are out of a job and need to find pastures new.

It is also concerning to see that only 72% of providers rated ‘outstanding’ manage to retain this rating. This can of course be down to a number of reasons, whether that be funding troubles or staff turnover. However, there must be a way that we can preserve the ‘magic formula’ that gained them the ‘outstanding’ rating in the first place.

The CQC outlines that one potential cause for the ongoing issues with the quality of care lies with the relationship with the manager and the owner/provider. Managers can be under huge amounts of pressure to make the business more economical in order to maximise profits, by doing so the reduction of staff is often the result.

It is paramount that the provider and the manager have a close and transparent relationship to not only insure that the business is profitable, but also the quality of care remains. It is completely understandable that a business is a business and there needs to be a profit, however, there are also people’s lives involved and we need to remain focused and delivering the best quality of care that we are able.

Technology

The adoption of technology is also a running theme throughout the CQC’s state of care report, with the regulators acknowledging that technology is being used in effective ways to genuinely improve the lives of service users. Technology is providing care organisations with safety nets; not only for the residents but also the staff and the business as a whole. Technology is here to help providers, giving them a fully auditable trail of the care that has been given in their home, eliminating the need to binders of paperwork to trail through. Software solutions also provide strong workflows, ensuring that all stages of the delivery and recording of care are being abided by.

We constantly speak with our clients to ask them how they are getting on with the software, and how their team are reacting to it. We have found a common theme is that team members feel more protected. They know that all care they give is recorded and backed up. Meaning there is evidence of the work they have done, without the risk of losing pieces of paper and charts.

Point of Care technology is also allowing carers more time with their residents. Although some people are concerned about carers using mobile phones to record care, they are actually recording their notes much quicker, allowing for more person-centric care with the residents.

Staff turnover

The workforce within adult social care services persists in being a huge worry for the industry. The staff turnover rate within the industry has been increasing year on year since 2012. The overall turnover rate for the sector was 31%, with Care workers and registered nurses at the top with 38% and 32% respectively. The vacancy rate for 2017/18 was 8.00%, increased from 6.6% in the previous year.

Not only is England struggling with building and maintaining its social care workforce, but the demand for adult social care is also rising. The UK’s population is ageing, meaning demand for care in always increasing.  This issue is, therefore, going to continue increasing if appropriate action isn’t taken soon.

This adds more pressure for the long-awaited social care green paper to be published by Matthew Hancock. Care organisations are being pushed to their limit, without the appropriate help from the government. With the paper soon to be published, it is simply a waiting game.

Importance of leadership

Carers are the driving force of the industry, however, in order to ensure they are continuously improving and driving person-centric care, you need a good leader. Home managers are always under an enormous amount of pressure to ensure the home runs, meaning leadership can soon take a backseat role. However, a team without a leader is like a ship without a heading. There needs to be a constant role within any care organisation to manage their team and ensure actions are in place to improve the quality of care in a  person-centric nature.

Person-centric care is a huge ‘buzzword’ in the industry, and there seem to be varying definitions of what it means. Published in the CQC’s state of care report is an insert from Louise, who says:

The key to good leadership is finding the balance between being a manager and a leader. There will always be the need for management to ensure the whole operates efficiently and the staff rotas are completed, however, there is much more to it than just this.

Good leadership starts with the culture of an organisation. The state of care report outlines the impacts of negative culture within the adult social care sector. Services rated ‘inadequate’ had a systematic issue with culture, where staff were reluctant to speak out of wrong-doing in case they got wrongfully blamed for it. However, they observed the rapid increase in the quality of care when new management was brought into the home with an ‘open door’ policy.

If your team are comfortable in approaching you about any concerns or possible improvements, you will then gain greater visibility into the everyday activities of your home.

Top Tip for improving your organisations' culture:

A study took place in which an organisation purchased a pink fluffy elephant. The elephant was given to a team member when they did something commendable. In the first instance, the manager would give a team member the elephant when they recognised good work. It was then up for the person in possession of the elephant to pass it on to another colleague when they felt someone else deserved it. It turned out that staff morale improved drastically. By having team members recognise each other’s hard work, rather than it coming from management nurtured a more inclusive and enjoyable culture. It also raises a speaking point amongst the team, “oh wow! You’ve got the elephant, what did you do?”.

This can be interpreted loosely, it could be a silly hat or the office mascot. Give it a try!

What did others think?

Craig Flood

Head of Implementation Services, iCareHealth

 

This recent CQC summary highlights some of the many challenges facing the adult social care sector namely:

–    Recruitment, retention, and development

–    Increasing demand for care combined with a decrease in nursing homes

–    The large variance in people’s ability to self-fund across the UK

Embracing technology and continued innovation in the adult social care sector can, and will, support the continuous improvement in care delivery.

“Harnessing the power of technology – Providers are starting to embrace new technology, which is having a positive effect on improving people’s quality of care, and the way services work together. Digital monitoring, e-prescribing, and assistive technology are all examples that are making a difference in people’s lives and the way they are cared for.”

Providing the ability to accurately assess, identify and document care requirements for individuals through technology allows providers to build robust digital records that are accessible to care, workers, residents, and relatives through cloud-based applications. In the first instance, harnessing the power of cloud technology opens the opportunity of point-of-care recording, increasing the accuracy of information and placing the resident at the centre of their records. And so, the journey of “Joined-up, high-quality care focused on people’s needs” is underway. A major milestone that we need to achieve is the delivery of secure and accessible care records across Health and Social Care, at which point we can truly start to harness the power of data for pro-active and predictive care delivery.

Ean Griffiths

Digital Marketing Executive

The State of Care report highlights the care sector is generally heading in the right direction. However, it is essential that care providers do not settle on the positive work that has been achieved so far; and continue to search for better ways to create positive work environments for staff and quality care outcomes for residents.

In Summary

These are interesting times for providers in the adult social care sector. We are in the middle of some massive issues; namely, staff retention, funding issues and mounting pressures from regulators.

The workforce in the sector is hugely admirable; working extremely hard to ensure the best quality of care for the residents. However, it is being made more and more difficult to do so.

Some tips in order to counter act these issues are:

  • Have a close relationship with the management and provider
  • Embrace and nurture a good company culture
  • Utilise technology to take some stress of your shoulders
  • Utilise development plans to retain and improve quality
  • Maintain a close and open relationship with your team to minimise staff turnover
  • Always put safety first.

I completely understand that there is no magic formula that will make all organisations ‘outstanding’, but these universal tips will help you on your way. If you have any questions or feedback, please let us know! Pop us an email to [email protected] and we will be more than happy to help.