Pete Sidgwick
and Ian Redfern gave a presentation to outline the work being
undertaken to prepare for the recommencement of CQC
inspections.
The presentation included slides on:
- Who are the
CQC?
- Why are CQC assessing
local authorities?
- The assessment
framework for local authorities
- The key aspects of
CQC local authority assurance
- The key components of
the approach
- Theme 1: How local
authorities work with people
- Theme 2: How local
authorities provide support
- Theme 3: Ensuring
safety within the system
- Theme 4:
Leadership
- The CQC six evidence
categories
- How we have
approached CQC assurance
- What we have done to
prepare
- Our CQC assurance
opportunities
- Our CQC assurance
challenges
- What improvement work
we are doing
- Next
steps
Pete Sidgwick provided a summary of the CQC
approach over the next two years to undertake baselining activity
of performance across the country. This would include a significant
new area for client level data for every person supported, by every
local authority in the country. It would be challenging as each
organisation had different ways of recording the data. It was viewed as a sensible way forward and would
give assurance to the public. He talked about the CQC approach for
one-word judgements ranging from ‘Outstanding’ to
‘Inadequate’. Pete provided assurance, exploring the
areas where Warwickshire needed to focus around waiting lists and
reviews. He explained the requirement for an annual review or
assessment for clients in receipt of long-term support as a
particular focus. From meeting with the CQC it was expected their
focus would be on safety. There would be a need to demonstrate that
services were safe and that clients’ care and support needs
were being met. Ian Redfern added there was a CQC expectation that
there would be areas for improvement in each local authority. It
was expected that local authorities should be aware of the
improvement areas and have realistic plans in place to achieve
them. Pete added that this would be a different oversight regime to
that of the Ofsted approach.
Questions and comments were invited with
responses provided as indicated:
- A member welcomed this approach,
whilst posing questions around the integration of health and social
care IT systems to provide the single assessment. She asked about
the arrangements for dementia services, using an example to show
the challenges faced. She looked forward to the new framework. Pete
Sidgwick spoke of the narrative for the documents which needed to
be concise and could not detail every service. It did explain how
people in different cohorts/groups were supported, including those
with dementia and their carers, also the services provided direct
and those commissioned from other providers. This process could be
uplifting and should be enabling rather than punitive. It was
considered that there was a positive account to give of
Warwickshire’s services, whilst wanting to learn and
improve.
- A councillor considered inspection
to be essential, particularly for public sector services in
identifying strengths, reinforcing good behaviour, reassuring staff
and to give examples of good practice that could be replicated,
whilst also addressing identified weaknesses. For councillors it would be helpful to have
similar inspection frameworks and reports across all the agencies.
He agreed that a service could not be assessed by a single-word
assessment. That said, it helped to prioritise endeavour and
budgets to secure improvement where it was needed. The Councillor
noted the value of securing client feedback via Healthwatch, adding
that surveying councillors may similarly be useful. He gave an
example to demonstrate this involving an unannounced visit to a
care home following concerns being raised by an elected member to
staff.
- Pete Sidgwick reminded members of
the Council’s statutory responsibilities not only for
services that it commissioned, but also around market shaping and
management. The example given could be good evidence of
intervention and the outcomes achieved. This process would bring a
transparency that would not be there without a regulator or
assurance framework. It would include reports to scrutiny giving a
level of openness which hadn’t been seen before. It was a
positive process which would inform decision making and budget
setting based on performance.
- An area discussed was the potential
outcomes from inspections and the measures that could be imposed,
including reinspection, or ministerial intervention. The CQC may
have a view already of the areas likely to need intervention and
the associated support. This would be part of the baselining
processes. Authorities rated ‘Good’ or ‘Requires
Improvement’ would likely have a list of areas of focus which
would then be reinspected at a future date. It was emphasised that
this was a new process and there were likely to be changes over the
next two years.
- A lot of clients were supported by
the NHS and social care. A key concern was effective communication
between the organisations, otherwise this may impact negatively on
the assessment of services. Pete Sidgwick confirmed that under Part
1 of the Care Act, there was a clear understanding of the duties
for social care. For joint areas such as continuing healthcare, the
local authority would be clear where its statutory duties ended. It
would need to demonstrate that, including in the customer focused
conversations and where the NHS funding started. Mr Sidgwick added
that the CQC would undertake assurance work of integrated care
systems. The conversations with customers would explain where
statutory duties lay. However, from the patients ‘lived
experience’ the arrangements would seem complicated, for
example around funding and financial contributions for social care
support. This process would uncover the historic differences which
the Government may need consider.
- Ian Redfern added that the CQC would
look to triangulate the information it received which would include
conversations with officers around any challenges identified in the
local system. Conversations were happening with partners as part of
the preparations to identify any such areas and to date the
feedback received had been positive.
- Chris Bain explained that all
‘enter and view’ visits from HWW were unannounced. He
broadly welcomed this regime as it may be slightly better, leading
to a common language and common understanding. However, experience
of CQC inspection findings and patient experience were not always
the same. The CQC gave advance notice of inspections, which put
staff under further pressure to prepare for the inspection.
Healthwatch would examine the impact on welfare for residents,
which should be the ultimate measure of success. If not, he
questioned why the regime was being introduced. Pete Sidgwick
responded that this was an assurance regime. Face to face contact
was part of the regime, but not all of it. Staff would build an
evidence log of how they worked, areas that needed to be improved
and how to improve services. This would be a continuous journey not
just when inspections took place periodically and it would
inevitably cause some additional pressures. The quarterly
submission of client level data would be interesting, showing
trends and potentially the need for interim discussions.
- Chris Bain added that some NHS
organisations had a tendency to focus on satisfying CQC
requirements rather than patient need. Pete Sidgwick assured that
the Council would not take such an approach of seeking to improve
individual metrics. It wanted this process to be meaningful. It was
a great opportunity to do the right things, celebrate the good and
to improve where this was required. It was not and could not be
just about satisfying the CQC, given the way this regime would
work.
- The Chair considered this to be
positive. Anything requiring improvement would be a learning
exercise too. She commented on the amount of data that would be
required but considered that Warwickshire did quite well, and staff
should take pride in what they did.
Resolved
That the Committee notes the presentation.