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Representing Your Views

NCF is dedicated to representing and voicing member concerns to the decision makers. We ensure member interests are represented at all levels and are in constant contact with government departments, politicians and the media to ensure your message gets across. 

Together we have a stronger voice!

Below is an indication of recent activity where we represent members at local, national and international levels. If you would like NCF assistance with a particular issue, please get in touch.


12 April 2017: Sharon Blackburn on behalf of NCF attended the CQC ASC Trade Association Meeting on 12 April. Slides available here

1. During the Consultation Update there were some queries regarding the Registering the Right Support guidance. Please see slides on phase 2 of the consultation from slide 10 onwards. Colleagues in the CQC policy team have clarified the following:

The plan is to publish the guidance with the Next Phase consultation on 11 May.

The guidance applies to all providers of health and social care services.  Health settings generally have more beds but they would be registering for ‘treatment of disease, disorder or injury’ and not accommodation with personal care / nursing. 

For providers of services that provide care, or that might intend to provide care in the future for people with a learning disability and/or autism who display behaviour that challenges, including those with a mental health condition, we will adopt the presumption of small services “usually accommodating six or less”. This position is in line with the current statements of best practice in Building the Right Support. 

We will not adopt ‘six’ as a rigid rule in any service for people with a learning disability and/or autism. We may register providers who have services that are small scale, but accommodate more than six people, where providers are able to demonstrate that they accord with all of the principles and values in Building the Right Support guidance, and meet the fundamental standards and other relevant regulations. 

We know that the provision of care to people with a learning disability and/or autism is complex. There are multiple factors that affect outcomes for individuals. CQC therefore does not consider the size of service in isolation from other considerations, which include, but are not limited to: skills of staff; effectiveness of management; and evidence base for the proposed care model. As such, we recognise the need to have a measure of flexibility in regards to the size of services. 

In line with the evidence which underpins the national model, that smaller services are better able to provide personalised care than larger services, CQC remains of the view that smaller units are likely to be preferable for people with a learning disability because they promote the underpinning principles set out in Building the Right Support (which our regulations require us to apply).  

2. As of 3 April it is important to note that of all services rated the number of Care Homes with Nursing stands at 4,008. This is a significant reduction of care homes with nursing. NCF as well as CQC and other Trade Associations are raising this trend in a range of settings as it will impact Primary Care and the NHS. See slide 3 of ASC ratings power point

3. DH and DCLG are developing, in consultation with the ADASS, LGA, NHS E and NHSI, a set of metrics – including, but broader than, DTOCs – to assess patient flow across the NHS and social care interface. Following the development of the metrics we will ask the Care Quality Commission (CQC) to carry out targeted reviews in a small number of areas, starting as soon as is practical from May 2017. These reviews will be focused on the interface of health and social care and not cover wider council social care commissioning. This should lead to a tailored response to ensure those areas facing the greatest challenges can improve rapidly. Andrea Sutcliffe CQC Chief Inspector ASC advised as per slide 8 of the general slide pack…20 reviews will be undertaken. CQC will focus on quality and improvement. The Terms of Reference are still being agreed. DH will use metrics that McKinsey have already produced. A Social Care Special Advisor is being sought to work with CQC. A timetable for the programme is being planned. It has to be completed by March 2018. A central team within CQC is being identified to lead this work, the work will be led by CQC Primary Care directorate which incorporates integration. ASAC are very much engaged and will influence this work. Sir David Behan is clear that DH have to fund this separately and that it must not come from provider fee income.

4. Slides 23 -26 inclusive re role of care staff/nursing assistant and Associate Nurse roles were discussed in a much wider context than the slides capture. Sharon Blackburn had requested that this be on the agenda as recent Associate Nurse role standards from HEE could have untended consequences for the roles that many care staff currently fulfil across health and social care. 

5. CQC Statement on the new approach to disclosure of inspection notes please see attached. This is response in response to queries made on behalf of members. CQC have given permission for circulation. 



30 March 2017: The CQC Adult Social Care external co-production group met at the end of March. Below are the attachments from the meeting:

Presentation

A copy of the letter sent to local authorities by the Department for Communities and Local Government informing them that CQC has been asked to review how health and social care work together

A copy of the summary document from the January meeting

A copy of the handout from session 1 on Repeat Requires Improvement Framework


8 March 2017: CQC ASC Trade Association met on the 8 March. NCF was represented by Sharon Blackburn. Resources are available below: 

One is a statement prepared in response to queries raised by National Care Forum members regarding providers’ requirements for reporting safeguarding and death notifications. 

The slides from this meeting are now available

there are also a second set of slides available here

If further queries arise as a result of this response please do advise Sharon-Sharon.blackburn@nationalcareforum.org.uk

The spring CQC consultation is due in May 2017 as is the outcome from the winter consultation Registering the Right Support.

The spring consultation will focus on:

- How CQC will regulate ASC and primary medical services from October 2017

- How CQC will regulate new and complex providers

- Fit and Provider Person Requirements for Directors


8 February 2017: Sharon Blackburn attended the CQC ASC Trade Association meeting on 8 February on behalf of NCF. Please see attached The slides from the meeting

17 January 2017: Sharon Blackburn attended the CQC ASC Trade Association meeting on 17 January on behalf of NCF. Please see below for:

The slides from the meeting

The response from John Forrest on Action Dec 16/09 regarding challenges to ratings made to the Ratings Review Team which was not attached to the previous email

Please also note that the Provider Survey is currently open and will close on Thursday 2nd February. Trade Associations are encouraged to kindly cascade this link to their members


14 December 2016: The CQC Trade Association meeting took place on 14 December. NCF was represented by Sharon Blackburn. The slides are available here

Please note details on the consultation launching later this week on slide 18. Minutes will be sent prior to the January meeting, which is scheduled for Tuesday 17 January, 10-12.30pm. If you could send your RSVPs to coproductionevents@cqc.org.uk that would be much appreciated.

Please also see below as promised queries raised by colleagues and CQC’s written responses.

1.       CQC guidance on notifications: Provider received conflicting guidance’s regarding the regulation 18, specifically Serious injuries. The guidance stipulates that the “Registered persons must notify us whenever any of the injuries occur that are shown on our form” however we have been told to report minor head injuries. Are we only required to report the items listed in the form as serious injury?

Reg 18 (2a and 2b) requires the registered person to notify CQC without delay of incidents which occur whilst services are being provided in the carrying on of a regulated activity, or as a consequence of the carrying on of a regulated activity.  There then follows a list (which is not exhaustive), plus guidance which gives a steer to the interpretation of “serious” i.e. leads to permanent damage or damage lasting more than 4 weeks, including to the body, sensory organs or e.g. speech, thinking, remembering; or psychological harm.  In the case of “minor head injuries” I think this would need a medical opinion about the extent of any damage (it may not initially be notifiable, but it may cause something later on and therefore be related to the carrying on of the regulated activity which caused it). Also, if the minor head injury were to be repeated within a few days the accumulation of any damage could be very serious.

2.       With regards to reporting “Abuse and allegations of abuse”- should we wait until the local authority safeguarding team confirms the case as safeguarding before reporting to CQC.

Where actual or alleged abuse is clear, notifications should be made as soon as possible to CQC and the provider should alert the LA.  The provider should send in the Reg. 18 notification as soon as they become aware. This allows CQC inspectors to take action that might result in a responsive inspection because of the nature of the notification.

3.       Provider would like to see a risk based reporting system, i.e. CQC does not want to be informed insignificant to minor incident that are unlikely or rare chance of reoccurrence ( I know this seems self-explanatory but we get contradictory advise when we phone CQC)   

We want information which is significant, whether or not there is a probability of recurrence.  We want to know how the provider has responded and acted to prevent recurrence and this is something we would want to follow up.

4.       When do you expect the provider portal to be open to providers with 10+ locations?  

We are waiting on DH and GDS permissions to enable us to move forward with the next phase of developing provider facing services. Any new services will be able to be accessed by providers of all sizes including those with 10+ locations.

5.       One of our members had heard that there is now a greater possibility of submitting additional evidence during the factual accuracy stage and that this has come about as the result of a ruling. Is this correct? If yes, I think it would be helpful to share this with the trade assoc group. Also, if yes, please could you send me a link to the relevant judgement?

We are strongly advising providers to use only the new factual accuracy (FAC) form to submit comments as part of the FAC process.  Providers may wish to submit additional evidence which was available at the time of the inspection (i.e. not created afterwards), but which is not discussed in the draft, and the provider believes it should be included in the report.  Guidance is clear that providers need to be specific about the part of the report that they wish to challenge, so that it can be dealt with effectively and efficiently.  Comments should be submitted up to 10 days after the provider receives the draft report. Link to the judgement

6.       Can providers request (and expect to receive) a copy of the inspection plan for a service?

Not as a matter of course as it may contain confidential information.

7.       Feedback on the proposal to remove the 6-month limit on a focussed inspection being able to impact on a rating: providers were concerned that this would work to their disadvantage. For instance, if a provider was rated good overall but had RI for responsive, then received a focused inspection due to a concern which resulted in them getting RI for safe.  Providers were concerned that this would mean that the overall rating would drop to RI even if the previously identified deficit concerning responsive had been remedied.

If the ‘responsive’ issue being remedied means the RI rating is no longer valid, we would re-inspect and re-rate. Beyond that, the provider should be able to demonstrate sustainability of improvement in the service and inspector should determine if it is another ‘isolated’ issue that they have confidence could be remedied by the provider or whether there were deeper issues (under well led) that would affect the overall rating.

8.       Providers are also looking for clarity about what happens when a CQC inspector starts out doing a focused inspection, but then a concern arises during the visit; how would the CQC inspector approach the inspection if the scope started to expand?

The inspector would amend the focus of their inspection accordingly – this is set out in the provider handbook – pages 30 and 32.


9 December 2016:  The CQC ASC trade association meeting took place on 9 December, with Sharon Blackburn representing NCF.

The minutes and meeting slides from 9 November Trade Association meeting are available


12 October 2016: CQC ASC Trade Association meeting took place on 12 October. NCF was represented by Sharon Blackburn. The slides when available will be made available to members via the newsletter. 

Key items discussed included:

- CQC Plan to have completed all ASC inspections by the end of January 2017 with all reports being published by the end of March 2017.

- on 27 October 2016 CQC will publish a document regarding visiting in care homes. When received NCF will share.

- in response to an NCF query re CQC Inspectors being employed by providers to carry out independent quality reviews. CQC introduced ' declaration of interest forms' in 2015 for staff engaged by CQC to complete and submit. If CQC inspectors are employed in a bank capacity then this form is completed ahead of each contact with a provider where an inspector operates in an independent capacity. If a CQC Inspector is employed either full or part time then this form is completed annually. Inspectors are not allowed to formally inspect services where they have been engaged in a private capacity. Where this has been breached or declarations not made CQC have taken action.


26 September 2016: Sharon Blackburn represented NCF at the Care Provider Alliance (CPA) meeting on Monday 26 September. Maria Bench from the Local Government Ombudsman (LGO) attended the meeting. Please see attached fact sheet for information .

People who fund their own care have had access to the LGO since 2010. LGO are keen to ensure that all people using services know about them. In an ideal world LGO believe that complaints should be resolved locally.


14 September 2016: CQC ASC trade association met on Wednesday 14 September. NCF was represented by Sharon Blackburn. The slides presented at the meeting are now availablePlease also see, this weeks’ list of inspection reports published including links to the reports.

Mental Capacity Act briefing - Case law on covert medication

Code of Practice on confidential personal information

Last week CQC published our code of practice on confidential personal information - this explains how we sometimes need to use our statutory powers to look at people’s information during inspections. People need assurance that the information they provide us with will be handled safely. We consulted on proposed updates to the Code earlier this year, and have published the revised Code and details of what has changed here.


10 August 2016: CQC ASC Trade Association Meeting met on 10 August. NCF was represented by Sharon Blackburn. The slides presented at the meeting are now availablePlease also see, this weeks’ list of inspection reports published including links to the reports.

Key points to note are: 

- Should a CQC Inspector tell a provider in the day of Inspection that they never award ' outstanding' the advice from Deputy Chief Inspectors at the meeting today was to action immediately by contacting the Inspectors Line Manager to talk this through as it is not CQC policy. If not resolved a complaint should be considered.

-Draft Guidance on Visitors' Rights in Residential ASC services was shared and discussed. The document needs more work before being finalised. NCF contributed that this should be written from the perspective of the person residing in care, not from the perspective of visitors. This has been tweeted by CQC as is available for providers to comment on . Provider log in details are required hence not providing a link here. More will be carried out via the ASC Co- production group. Publication due late September/ early October

- an Outstanding Tool is being developed. It will be guidance to help inspectors and providers better understand what it takes to be 'Outstanding' for each of the five key questions.

- CQC  digital development Research and Discovery: access to the Provider Portal is being expanded. Research is under way with providers. If you would like to get involved please contact : Providerportalengagement@cqc.org.uk

They are reviewing the provider portal; new registration system and the Provider Information Return. In addition this work is aligned to the CQC Strategy 2016-20 and is very cognisant of avoiding and reducing duplication of entry for providers. CQC aim to be the conduit of information for other organisations and are working with ADASS and others to achieve this outcome.


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