CQC Advice For Care Homes When the Hot Weather Returns

The CQC has issued advice to those caring for the elderly, vulnerable and disabled during the hot weather.

Making sure patients and clients are properly cared for during hot weather falls under the umbrella of making sure services are ‘safe’ and having processes and procedures in place to manage the effects of hot weather is critical

Andrea Sutcliffe CBE, Chief Inspector of Adult Social Care, said: “While many of us are enjoying the heatwave, the risks of overheating and not getting enough to drink are much greater for older people and people in vulnerable circumstances.

“That is why it is so important that those living in care homes and other health and care settings, particularly people living with long-term illnesses and complex conditions, are appropriately monitored and supported to maintain their usual health and wellbeing.

“Most of this is common sense – thinking about the environment and having person-centred care plans will help you to identify people at greatest risk and make sure they have the support they need.

“There’s also lots of good advice available from Public Health England and NHS England in the Heatwave Plan for England including specific advice for care homes as well as hospital services. Information published by the Care and Support Alliance has a useful section on extreme weather conditions too.

“So, let’s enjoy the summer sunshine but let’s prepare and be #TempAware too.”

Excerpts from the Public Health England’s Heatwave Plan for England are below, but we urge all those involved in providing services for the elderly, disabled and vulnerable to take a look at the full document.

Heatwave Plan For England  – Advanced Preparations

Buildings and surroundings:

  • check that windows can be shaded, preferably by curtains with pale, reflective linings rather than by metal venetian blinds and curtains with dark linings, which can make conditions worse – if these are fitted, check that they can be raised
  • check that there are no problems opening windows while acknowledging security considerations
  • increase outside shading, in the form of shutters, shades, trees or leafy plants; reflective paint can also assist in keeping the building cool. Increase outside greenery, especially in concreted areas, as it increases moisture content and aids cooling as a natural air conditioner
  • cavity wall and loft insulation help to keep the building warm in winter and cooler in the summer – contact your local authority’s energy efficiency officer or your energy company to see what grants are available
  • create cool rooms or cool areas. High risk groups that are vulnerable to the effects of heat, physiologically find it hard to cool themselves efficiently once temperatures rise above 26ºC. Therefore, every care, nursing and residential home should be able to provide a room or area that maintains a temperature at 26ºC or below
  • cool areas can be developed with appropriate indoor and outdoor shading, ventilation, the use of indoor and outdoor plants and, if necessary, air conditioning
  • ensure that staff know which rooms are the easiest to keep cool and which are the most difficult, and review the distribution of residents according to those most at risk Heatwave plan for England – supporting vulnerable people before and during a heatwave – advice for care home managers and staff 7
  • indoor thermometers should be installed in each room in which vulnerable individuals spend substantial time (bedrooms and living and eating areas) – during a heatwave, indoor temperatures should be monitored regularly
  • electric fans may provide some relief, if temperatures are below 35ºC (note, use of fans: at temperatures above 35ºC fans may not prevent heat-related illness. Additionally fans can cause excess dehydration; the advice is to place the fan at an appropriate distance from people, not aiming it directly on the body and to have regular drinks – this is especially important in the case of sick people confined to bed)

Working arrangements:

  • ensure business continuity plans are in place and implement as required (sufficient staff must be available so that appropriate action can be taken in the event of a heatwave)
  • get extra help from relatives of residents and volunteers
  • provide an email address to local authority/NHS emergency planning officers, to facilitate the transfer of emergency information
  • identify cool areas in the care home
  • increase awareness of staff to heat-related illness and health protection measures


  • check that you have an adequate supply of fans and water sprays – install thermometers
  • check that water and ice are widely available – ensure that you have a supply of oral rehydration salts, orange juice and bananas to help maintain electrolyte balance for those on diuretics
  • arrange for cold drinks to be distributed regularly in the event of a heatwave
  • plan to adapt menus to cold meals (preferably with a high water content, such as fruit and salads) in consultation with residents


  • make sure you know who is most at risk – ask primary care staff if you are unsure and record it in their individual care plans
  • ensure that you have protocols to monitor residents most at risk and to provide additional care and support (room temperature, body temperature, pulse rate, blood pressure and dehydration will need to be monitored)
  • ask the GPs of at-risk residents about possible changes in treatment or medication in the event of a heatwave and review residents on multiple medications
  • check that residents have light, loose-fitting cotton clothing to wear
  • be aware that plastic pads and mattresses can be particularly hot during a heatwave

What To Do When You Know A Heatwave Is Coming

  • identify high-risk residents/patients
  • if temperatures exceed 26ºC, high-risk individuals should be moved to a cool area that is 26ºC or below – for patients who can’t be moved, or for whom a move might be too disorienting, take actions to cool them down (eg liquids, cool wipes) and enhance surveillance
  • check local weather forecasts on the radio, news, websites (eg www.metoffice.gov.uk) or paper
  • check that staff, and others such as volunteers, know what to do during a heatwave
  • suggest that all residents consult their GP about possible changes to their treatment and/or medication; consider prescribing oral rehydration salts for those on high doses of diuretics
  • check indoor temperatures are recorded regularly during hottest periods in all areas where patients reside
  • communicate alerts to staff and make sure they are aware of heatwave plans
  • prepare cool areas and provide regular wet towels and cool foot baths
  • ensure sufficient staffing


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More Students Than Ever Are Being Awarded Unconditional Offers For University

UCAS analysis of applications and offers patterns in England, Northern Ireland and Wales shows that students are increasingly likely to be made an unconditional offer for a place on an undergraduate course, before they have completed their qualifications at school or college.

The number of unconditional offers made to 18 year old students has risen over the past five years – from 2,985 in 2013, to 67,915 in 2018. This year, 7.1 per cent of offers made to these students were unconditional, continuing the recent trend of annual increases.22.9 per cent (58,385) of these students received at least one unconditional offer – a rise of 29 per cent on 2017.

When universities make an offer, it can either be conditional or unconditional. Conditional offers usually specify the grades a student needs to achieve in their A levels, BTECs, or any other relevant qualification, to be accepted onto a course. Unconditional offers don’t have any further academic requirements the student needs to meet.

Unconditional offers have always been a part of the admissions process and are used in a variety of circumstances, including:

  • to mature students who have already achieved their qualifications to meet entry criteria
  • to those applying for creative arts courses, after submitting a portfolio, or following a successful interview or audition. Artistic flair is likely to be viewed as a better indication of potential than traditional grades
  • to reduce the stress some students may feel during the high pressure  exam period, supporting students with mental health difficulties
  • as one of the many different approaches universities use to attract and retain interest from students in a competitive marketplace

Helen Thorne, UCAS’ Director of External Relations, said: ‘Students should take the time to carefully think about all their options fully before accepting an unconditional offer. Information and advice on the UCAS website highlights the key points students need to think about before accepting any offer.

‘While unconditional offers are made for a number of reasons, we believe that universities should always emphasise to students the importance of completing their studies to the best of their abilities. This will help make sure they’re well prepared for their degree course, and for future employment.

‘Later this year, we’ll be publishing more detailed analysis of offer-making, including any impact on students’ attainment.’

Commenting on the UCAS report on unconditional offers, Alistair Jarvis, Chief Executive of Universities UK, said: “While there has been a steady growth in the number of unconditional offers made, they still account for a small proportion (7.1%) of all offers made by universities.

“Such offers can be made in a number of circumstances, including offers to applicants who already have qualifications. And to applicants with extensive practical and relevant experience for courses such as music or journalism. They can also be awarded where evidence suggests applicants are clearly on track to exceed the required entry grades, and to applicants from disadvantaged backgrounds with the potential to do well at university with additional support.

“Unconditional offers, when used appropriately, can help students and ensure that universities are able to respond flexibly to the range of applicants seeking places. Universities UK will continue to work with UCAS to monitor trends and any impact unconditional offer-making might have on student attainment. It is simply not in the interests of universities to take students without the potential to succeed.”

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Changes to CQC’s Attitude Towards Management of Controlled Drugs

The Care Quality Commission (CQC) has published its annual review of the management of controlled drugs in England.  The report looks at the performance of those managing controlled drugs in England under the Controlled Drugs (Supervision of Management and Use) Regulations 2013 and make recommendations for the future.


  1. Prescribers should ask patients about their existing prescriptions and
    current medicines when prescribing controlled drugs. Where possible,
    prescribers should also inform the patient’s GP to make them aware of
    treatment to minimise the risk of overprescribing that could lead to harm.
  2. Commissioners of health and care services should include the governance
    and reporting of concerns around controlled drugs as part of the
    commissioning and contracting arrangements so that these are not
  3. Healthcare professionals should keep their personal identification badges
    and passwords secure and report any losses as soon as possible to
    enable organisations to take the necessary action.
  4. Health and care staff should consider regular monitoring and auditing
    arrangements for controlled drugs in the lower schedules, such as
    Schedules 4 and 5, to identify and take swift action on diversion.
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UK Publishing Has a Record Breaking Year

The Publishers Association has published its yearbook for 2017 and its good news for authors and booksellers!

The UK publishing industry had a record-breaking year in 2017, with income up 5% to £5.7bn.

The industry is already the number one exporter of books in the world and export income rose a further 8% to £3.4bn in 2017, accounting for 60% of total revenues.

Drilling Down Into The Stats

  • Total book sales income (Physical and digital books) is up 4% to £3.7bn
  • Total digital sales income (Digital books and journals) is up 3% to £1.8bn
  • Total physical book sales income is up 5% to £3.1bn
  • Total journal sales income is up 5% to £1.6bn
  • Total journal export income is up 5% to £1.4bn
  • There has been an 11% increase (to £284m) in the export sales income of non-fiction/reference physical and digital books.
  • Sales of physical books to Europe increased 13% to £489m, and to East and South Asia by 8% to £248m.
  • Digital school book sales export income has risen by 93% to £10m.
  • Export sales income from journals rose 10% to £565m in North America, which is the largest international market for journals – accounting for 41% of the export market.

How are digital sales doing?

  • Total digital sales income (Digital books and journals) is up 3% to £1.8bn.
  • Digital book sales income is down 2% to £543m.
  • Audiobook sales have risen 25% to £31m.
  • The sale of school digital books is up 32% to £27m, suggesting that the use of digital teaching resources is becoming more prevalent.
  • Non-fiction total digital book sales have increased by 4% to £50m, suggesting consumers are increasingly reading non-fiction, cookbooks, illustrated books and reference books on their devices.

How is consumer publishing performing?

  • Fiction sales income (physical and digital) is up 3% to £547m.
  • Non-fiction/reference sales income (physical and digital) is up 4% to £928m.
  • Home non-fiction/reference physical book sales income is up 2% to £620m.
  • There is an uplift in hardback fiction book sales income, up 31% to £97m.
  • Children’s total physical and digital book sales income is down 3% to £341m.

How is education publishing performing?

  • There was a 3% drop in overall physical and digital school book sales income to £324m.
  • While domestic sales for physical school books are down 12% to £158m, there was a rise of 2% in export physical school book sales to £93m.
  • Overall digital school book sales performed better than physical, with domestic sales income up 12% to £17m and export sales income up 93% to £10m.
  • Total ELT physical and digital book sales are up 13% to £293m – with physical sales up 13% to £20m and digital sales up 13% to 20m.

How is academic publishing performing? 

  • Physical and digital academic and professional book sales income is up 6% to £1.2bn.
  • Journal sales income is up 5% to £1.6bn.
  • There is an increase in sales income for social science/humanities (SSH) physical books, up 9% (to £693m), and scientific/technical/medical (STM) physical books, up 8% to £250m.
  • Total income from Open Access charges is up 21% to £148m.

Stephen Lotinga, Chief Executive of the Publishers Association said “These figures reveal another stellar performance from the UK publishing industry. From blockbuster novels to the textbooks and research papers which shape our thinking, today’s statistics prove that society’s love of books in all forms shows no sign of waning.

“Publishers are catering to modern consumers who are reading books in different formats across different platforms, but still showing a very significant attachment to the printed word, as we continue to see the resilience and popularity of print across publishing sectors.

“Export income has increased significantly and this increase is testament to the high regard UK publishers, authors and their work are held in around the world – and the continued appetite of readers for them.”



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Embracing New Technology to Support Patients and Carers Leads to CQC Outstanding Rating

Bluebird Care East Devon in New Street, Devon, a domiciliary care agency, has been rated Outstanding by the Care Quality Commission following an inspection in May.

Inspectors rated the service Outstanding for being effective, caring, responsive to people’s needs and well-led and Good for being safe. The overall rating is Outstanding.

Bluebird Care East Devon provides personal care to disabled adults in their own homes. There were 42 people receiving care at the time of the inspection.

Some of the key findings from the inspection include:

  • People and relatives were overwhelmingly positive and praised staff describing them as exceptionally caring and compassionate. Comments to inspectors included: “We’ve found every aspect of care to be outstanding,” “I am treated with respect, the carers are more like friends,” “Thank you Bluebird Care you have been a help and I think I have made new friends.”
  • Staff supported people to express their views and be proactively involved in making decisions about their care, treatment and support in innovative ways. The service undertook a ‘Talk Care’ campaign to promote a conversation about care  that was positive, informative, open-minded and inclusive. Views were sought on social media on ageing, perceptions of what care means and any other questions. From the conversations, they made a series of informative short videos to identify key things people needed to know about care. These were posted on social media and enabled people and families to be better informed about care options and what was important in planning their care.
  • The service worked in innovative ways to enrich people’s lives. For example, they had a Wellbeing programme, facilitated by a Wellbeing Ambassador who supported the local care team to host monthly wellbeing events including regular coffee mornings, tea dances, exercise to music, reminiscence sessions, quizzes and bingo. These monthly wellbeing events gave people an opportunity to meet and socialise, renew friendships and make new friends with office and care staff and get to know them better.
  • Sensor technology was used to enable people to stay living longer at home. Sensors fitted in one person’s home monitored how often they moved around and detected any changes in their normal pattern. For one person using this service, frequent trips to bathroom highlighted early signs of a urine infection. This meant the person was seen earlier by their GP and antibiotic treatment started, which helped them recover more quickly

Deborah Ivanova, Deputy Chief Inspector, Adult Social Care, said “Bluebird Care East Devon is a service that places people at the very heart of its operation and makes them feel valued and respected. We found great examples of the service working in innovative ways to provide outstanding care that enriched people’s lives and allowed them live independently. These included the use of sensor technology to monitor and respond to changes in care needs and the ‘Talk care’ campaign which led to the development of a series of videos to support people’s choice in care planning.

“To achieve an Outstanding rating overall is a commendable achievement and the staff and management at the service should be very proud of the compassionate, person-centred care they are providing”.

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Office For Students Calls on Universities to Look Beyond A Level Results

The Fair Education Alliance has issued a report (based on research from the University of Exeter) which calls on universities to improve the ways in which contextual data is used during the admissions process.

The CEO of the Fair Education Alliance Sam Butters said “We want to see change in widening participation within the most selective universities. We know that parents’ income, the quality of school attended and a myriad of other background factors affect educational outcomes for young people, including how well they do in their exams and their likelihood of progressing to Higher Education. Contextualised admissions are a way of overcoming this challenge and recognising the additional barriers disadvantaged young people face but we need some changes to how the practice is being used for it to be effective.”

The report’s authors observed how contextual data is used in practice at highly selective universities and the report focuses on how best practice can be shared across the sector, making access to education in the UK fairer.

The report’s findings include:

  • Many universities have undertaken new approaches to the admissions process, through ‘contextualisation’ in admissions processes; where data is matched to applicants to assess an applicant’s prior attainment and potential to succeed in higher education in the context of the circumstances in which their attainment has been obtained.
  • The use of contextualised data in admissions has become increasingly more accepted over the last five years and the practice more widespread.
  • Although now widely accepted, contextualising admissions are applied in a wealth of ways across HEI’s; and it is often unclear to applicants exactly which practices are undertaken.
  • Currently a wide range of approaches are adopted by institutions to determine how ‘disadvantage’ is defined; with issues of inconsistencies across the UK and a problem of missing data.

Most critically the variety of contextual data sources and measures used is making it difficult for potential applicants and their advisers to assess where and how their chances might be enhanced, and the benefit of encouraging more applicants from non-traditional backgrounds is lost.

Recommendations by the OfS include:

•    Public buy-in and Office for Students (OfS) support for the practice
•    Improved access to relevant data for institutions
•    Accountability for institutions on relevant data measures
•    Increased transparency for applicants
•    Greater consistency around principles and terminology
•    Shared commitment to measuring impact on student outcomes

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CQC Publishes Updated Approach to Regulating Independent Healthcare Services

Following a consultation earlier this year, the CQC has updated its guidance for independent healthcare providers in England.

The guidance sets out how the CQC will begin rating independent healthcare services that were previously unrated, such as independent ambulance services, independent substance misuse services and cosmetic surgery services.

Following inspection, ratings will be awarded for whether these services are safe, effective, responsive, caring and well-led at overall service and location level, using the same ratings principles used for all other services.

The guidance also confirms that as part of the changes the CQC will:

  • Introduce ‘CQC Insight’– a data monitoring tool currently in use for NHS hospital trusts and primary care providers – for independent healthcare services, starting with mental health and acute services.
  • Strengthen their relationship management with providers and with local and national stakeholders.  Adopting a more intelligence-driven model of regulation informed by ongoing monitoring of the quality and safety of care.
  • Move towards unannounced inspections and introduce maximum re-inspection intervals based on location ratings.
  • Assess and rate ‘outpatients’ and ‘diagnostic imaging’ services separately to better reflect the way these services are organised and managed at many independent hospitals.
  • Over time, the CQC will develop a digital routine provider information request to further improve their ability to monitor services.

The changes will be phased in over time, starting in July 2018.

The CQC will also be producing separate updated provider guidance for Independent doctors and clinics providing acute and primary care, including online prior to beginning to rate these services in April 2019.

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Too Few SMEs Have Plans in Place to Cope With Identified Risks

Many small businesses are unprepared for the impact that disruptions from cybercrime, staff losses and severe weather can have on their day to day running.

According to new research by the Federation of Small Business (FSB), looking at how larger businesses and government departments can better support small businesses in their supply chains, only 35% of small businesses and the self-employed reported having plans in place to cope with potential disruption risks to their own business operations or their supply chain’s.

The most prevalent risks identified to small firms were:

  • customers who failed to pay for services or goods (51%)
  • the loss of key members of staff (37%)
  • IT problems (29%)
  • the impact of cybercrime (17%)
  • severe weather (13%)
  • and even the dangers of terrorism (1%).

Smaller businesses are the most vulnerable to such risks due to their size and lack of resources.

The FSB is calling on companies in supply chains to help smaller businesses, with fewer resources, providing assistance with forward planning.

They are also calling on the government and Local Authorities to emphasise the need for smaller firms to have continuity plans in place as a routine measure.

FSB National Chairman, Mike Cherry, said: “Small businesses face a number of threats on a regular basis and it is vital they are prepared to deal with them. By implementing continuity plans, small firms can prepare for many of the sudden changes that can impact on them directly and their supply chains.

“One key step towards ensuring a business is prepared for any supply chain difficulties is continuity planning. This includes identifying the most significant risks to a business’ commercial operations and creating a plan to mitigate those risks should any of them materialise.

“The costs that businesses face when their supply chains are impacted can be severe and therefore it is crucial that we stress the importance of planning for the future.”

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CQC Reports Urgent Primary Care Services Doing Well Despite Pressures on the System

The CQC’s latest report on urgent primary care services shows that the majority of walk-in and urgent care centres, NHS 111 and GP out-of-hours services in England are doing well, with 128 rated good or outstanding (around 9 out of 10).

The report goes on to look at the relationship between these services and the wider health service, recognising that well run and adequately resourced services ease pressure within the system as a whole.  Commissioners are urged by the CQC to recognise these secondary benefits when allocating resources.

Key Challenges

Aside from resourcing issues, the CQC highlighted a number of other specific challenges faced by urgent primary care providers, include pressures around staffing, compounded by the reality of unsocial working hours and high reliance on self-employed clinicians, difficulties in accessing people’s medical records.

While the majority of care is rated good or outstanding, voluntary sector groups also raised concerns that there is a lack of public information about which services to contact and when, and that people require guidance to overcome an historic reliance on accident and emergency.

Professor Steve Field, Chief Inspector of General Practice at the Care Quality Commission, said “Well-resourced and integrated urgent care not only provides safe, high-quality care to people, but can also ease pressure on other areas of the NHS – particularly emergency departments during the winter period and other times of peak demand. These benefits should not be overlooked.

“It is encouraging that the majority of care is rated good or outstanding and important that commissioners and other services recognise the value that urgent care offers as part of integrated care for people in a local area. As CQC’s interim work reviewing local systems has shown, the relationship and interaction between services is vital to better patient experience and outcomes.

“The work already underway by NHS England is an important step in driving better care for people. However, there is more to be done to make sure complex commissioning arrangements and gaps in public information do not undermine care or undervalue these essential services.”

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Parliamentary Group to Investigate Steep Fall in Author’s Earnings

The All Party Parliamentary Writers Group, which keeps MPs and Lords from all sides of the political spectrum informed on issues pertinent to writers, has launched an inquiry into authors’ earnings and to identify what environment writers need to enable them to flourish in the future.

Launching the investigation the group said “Writers contribute to the richness of our diverse culture and the success of our creative industries. To preserve this continued contribution, it is important to make sure writers have the freedom to share and make a living through their work.”

Who should participate?

The Group would like to hear from all types of writers as well as the organisations involved in the industry including unions, agents and publishers.

Why is it necessary?

Two prominent reports into authors’ earnings, commissioned by the Authors’ Licensing & Collecting Society and carried out in 2005 and 2013 have shown a steep decline in both authors’ earnings and the number of authors who made a living from their writing.  In the 2005 report carried out by the University of Bournemouth the number of professional writers (those who dedicate the majority of their time to writing) who earned their living solely from writing was 40%; by 2013 in a report carried out by Queen Mary, University of London, this figure had fallen dramatically to 11.5%. The results of a more recent survey are due out during the lifespan of this inquiry. Both reports also identified a downward trend regarding authors’ earnings. In 2005 the typical (median) income of a professional author was £12,220 but by 2013 this had fallen to £11,000.

The outcome of this Inquiry will be presented at the All Party Parliamentary Writers Group Winter Reception on 4th December 2018.

Aims of the Inquiry

The Group seeks to:

  • Further develop our understanding of how authors’ earnings have changed over time
  • Create an understanding of the market pressures and relationship that affect authors’ earnings especially in today’s digital and global economy
  • Understand the impact of the current legislative landscape on writers
  • Review the opportunities to improve the position of authors through legislation and regulation

Evidence Gathering

The Group invites written evidence on the following areas:

  • Professional challenges specific to authors such as regularity of earnings, varied sources of income, how these have changed and their impact on both the day-to-day livelihood and career of authors.
  • The position of writers within the creative industries, the market pressures on them and how they have been affected by the development of creative industries in the UK.
  • The Impact of Brexit on writers and copyright, how past and developing EU law and regulations have affected authors’ earnings and how this might change.

Your Input

Each submission should:

  • be no more than 3,000 words in length
  • be in Word format with as little use of colour or logos as possible
  • have numbered paragraphs

Written evidence should be submitted to luke.alcott@alcs.co.uk with the title “APWG Earnings Inquiry”.

The deadline for written evidence is 5pm on Thursday 2 August 2018

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