The aim of The Health and Care Act 2022 is to move towards an integrated care system, with a view to eradicating the divide between health care and social care. The changes within the Care Act have led to the Care Quality Commission (CQC) adopting a new approach with the main goal being better care delivery and a better understanding of what is possible for those individuals needing support. Every year brings changes and challenges and already only a month into 2023 we are aware of significant changes ahead. As a care provider you will need to embrace the changes being rolled out by the CQC and through doing so, lead your team onto better outcomes.
The new structure is referenced as a single assessment framework. One could suggest that the ‘single’ element could be interchangeable with continuous, holistic, or omnipresent.
The CQC’s single assessment framework has been designed so that one assessment can be applied to organisations with both health care and social care. A single assessment framework that allows for broad coverage whilst incorporating the nuances of the distinct, varying aspects of care delivery. An assessment that can be applied to Local Authorities, Integrated Care Associations, hospitals, GP practices, dentists, social care providers and any other organisation reviewed by the CQC. The assessment does this by using ‘I and We quality statements’ that are an opportunity for care provider to evidence the magnificent work they do whilst also highlighting the challenges they face.
The single assessment framework is being rolled out to make those delivering care more efficient with better risk management techniques. Crucially it will also make the CQC more efficient, creating greater scope for the governing body to be an enabler, propping up other organisations who specialise in actual delivery of care.
What Are The Changes?
It might be easier to start with the elements that are remaining; Key lines of enquiry (KLOEs) are the same, so you will be evidencing how your delivery is safe, caring, effective, well led, and responsive. Rating systems are the same; outstanding, good, requires improvement and inadequate. However, how you evidence the delivery of KLOE regarding the rating characteristic will evolve. You will now be using quality statements to explain how your organisation is meeting the criteria. The CQC will then weight each quality statement. This process could be compared to how you may currently conduct a risk assessment. One of the most fundamental changes will be to the site visits, with the CQC utilising Direct Monitoring Activity (DMA), in the form of calls and remote monitoring far more than they ever have. The theory being a light touch with greater frequency will offer a better understanding of the culture within the organisation in question. Also, this process will allow for a broader canvas of assessment, to include friends and family of those receiving the care and external agencies linked to your organisation. The CQC will, of course, maintain the ability to carry out site visits, which are more likely to be organised when a provider is struggling, or a risk has been found. This style of site visit is likely to have a sharper focus when compared to earlier CQC inspection experiences. The CQC will also be drawing a picture of your care from the Provider Information Reports (PIR) which again will be smaller and more frequent, most of which will pass through the online provider portal (expected Summer 2023). A continuous data collection that the CQC are requesting to help them build their holistic view. In turn this greater reliance on data will allow them to broadcast trends in care management on a regional and specific basis, helping care providers through shared best practice on a grand scale. Combining these elements will create a more holistic overview of your standards and culture and therefore a more realistic rating.
When Are The Changes Likely to Take Place?
The idea of the changes has been bounded about for some time. The CQC have been very vocal about launching effectively and using a phased roll out to increase the chance of success. The truth is that elements of the framework have already been trialled in some geographic areas for some forms of care providers, with over 7000 direct monitoring calls carried out last year.
Currently the full deployment for the framework is scheduled for Autumn 2023. But working in social care we are all very aware of how sometimes these timelines evolve. Watch this space.
Better risk assessment and risk management is the foundation for the changes. Covid has shown areas of improvement for the CQC and ways in which they can better structure themselves to help care providers. Ideally trying to create a scenario where risks are found sooner and managed more effectively. Rather than being responsive to a risk, reacting to something that may have been a risk for some time, or worse still, after an accident or incident, it is better to be proactive and avoid foreseeable risks at any given opportunity. So, the innovative approach should be geared in a way that spots those opportunities and maximises them.
Although we are aware of some resistance to these changes within the sector, these changes mean you should mean that the standard of care improves. The worry of an inspector landing on your doorstep for several days and going through your paperwork with a fine-tooth comb should no longer be a concern for those delivering quality care. The onus will be on you as a care provider to create a stream of valid and reliable evidence, without impeding your staff.
The changes are not upon us, but change management is always challenging, better to prepare now so that when the time comes it is easier for you and your team. Whilst supporting and keeping people safe now, there are some elements that you can review:
Take this opportunity to review your organisational governance and refine and evolve accordingly.
Set a performance framework with clear positive outcomes for everyone involved. This will help your team reach organisational aims.
Create the right support
Surround yourself with supportive suppliers and external agencies, caring for someone should not feel like a constant battle. There are lots of specialists that can help with the various challenges you may face.
Co-production of evidence
Create simple digital processes that promote and evidence the innovation and creative ideas created by you and your colleagues. Not forgetting to document the impact on the people in your care and the wider organisation.
Involve you team with the governance and ask the CQC for briefing docs about the upcoming changes. If your team knows what is expected of them and the desired outcomes, they can make their own decisions, even under pressure.
Create a feedback loop from those who are linked to your provision, family, friends and visiting professionals and external agencies. The CQC will be, so why not get ahead of the curve? Then try to listen and respond accordingly wherever you can.
As you are aware, social care professionals are not working in a vacuum. What can you and your colleagues do to support the wider community of health and social care? What can you do to engage more with the families and friends of those within your organisation?
Digital processes can save significant resources and free up your staff to deliver high quality, engaging care.
Health care and social care are two sides of the same coin, that over time have travelled in slightly different directions and are now being asked to realign to prop one another up. The CQC are rolling out a novel approach to fit in with the picture of a singular, fluid care system. As a care manager you will need to ask, ‘what can be done to reduce the burden on the care system?’ There are some topics that are more prevalent than others when talking about hospital submissions; falls, pressure sores, and infection control. Beyond that, a care professional’s ability to assess risks and the supervision structures directly affect the delivery of care. As a training provider we can supply courses in Falls Awareness, Infection Control, Pressure Sores, Risk Assessment and Supervision. We can even supply a Learning Mangement System (LMS) that helps with communication, evidence recording and allows you to share and build upon your performance framework. We wanted to go beyond that and have teamed up with Kata Care and Kaizen Business Consultants, so that we can offer you a full support package to guide you through the upcoming changes and help you to surpass regulatory expectations.
Our combined knowledge can help you to take the pressure away from the changes we are all facing. By getting the right support in place, the right tools for your staff and the right processes, you will be able to do what you have been trying to do all the time, pay more attention to those in your care.