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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Leadership, Communication and Collaboration Key to Improving GP Services

Leadership, communication and collaboration are among the key drivers of improvement for ten GP practices featured in a new report published by the CQC.

‘Driving improvement: Case studies from 10 GP practices’ draws on interviews with a broad group of staff from ten practices – nine of which were originally rated as inadequate and, through dedicated effort, improved to an overall rating of good on their last inspection. The tenth practice improved from a rating of requires improvement to outstanding.

At the heart of their progress was an understanding that everyone at the practice had a role to play – including clinical, nursing, administrative, managerial staff and patients – and the importance of recognising what each person could contribute to the improvement journey.

Through working with others locally, accepting the support available nationally and empowering practice managers, the practices contributing to this report demonstrated an impressive commitment to not only driving high-quality care for their own patients, but also helping others to learn from their experience.

All the practices interviewed faced similar challenges and shared some common experiences which are discussed in the report, such as:

  • ensuring practices had strong leadership from a practice manager with the time and skills to lead the practice team
  • addressing staffing and training issues such as poor recruitment or training practices
  • ensuring that every member of the practice team understood their role, communicating these responsibilities and involving the whole team in the running of the practice
  • realising the benefit of involving patients and the local community
  • accessing external support, whether locally or nationally.

Speaking about the report, Professor Steve Field, Chief Inspector of General Practice, said “This report is a celebration of excellent general medical practice, commitment to patient care and a testament to the hard work carried out every day by practice teams across England.

“I was thrilled to report last year that the vast majority of practices deliver good or outstanding care and I am similarly proud to share the amazing efforts of practices that took a step back and responded to less favourable inspection findings by using them as a springboard for real action and improvement.

“As general practice the first port of call for most patients, it is vital that we listen to what practices have to say and similarly, it is vital that they engage with the wider system and resist the professional isolation that can lead to poorer care. I am incredibly grateful to all of the practice teams who worked with us in pulling this report together. The lessons from these conversations can help other practices as they face the very real pressures of modern general practice at a time of growing patient demand and workload.”


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Family Background Shown to Impact on Graduate Earnings

It has been well documented that university graduates from certain subjects and from certain universities earn considerably more than others. For example, five years after graduation, men from the highest earning universities earn almost 50% more than graduates from other Russell Group universities (30% for women), while male Russell Group graduates earn over 40% more than those who attended the average post-1992 institution (35% for women). Meanwhile, economics graduates earn over 40% more than history graduates who in turn earn 15% more than sociology students.

But to what extent are the earnings differences across university courses down to the course itself, and to what extent are they due to differences in the students doing the courses?   In other words, do Russell Group and economics graduates earn more because they have better A levels and are from wealthier backgrounds, or does the subject you study and the university you go to have an effect over and above your background and prior attainment?

These are questions answered for the first time using large-scale administrative data in new research by a team led by the IFS and produced with funding from the Department for Education.

The results…

Prior attainment and socio-economic background do matter. Comparing graduates who attended the same university, took the same degree subject and who have similar background characteristics, every extra A-level at grade A raises your earnings by around 3%, while coming from the highest socio-economic background adds around 8% compared to coming from the lowest.

But crucially, the subject you study at university and the higher education institution you attend also matter a lot.

Earnings differences:

  • Economics and medicine students earn around 60% more than history and English students five years after graduation, around £40,000 per year compared to little over £25,000.
  • Typically, graduates of STEM subjects like physics and maths have higher earnings than subjects like psychology and sociology.
  • Those who studied creative arts, social care and media earn the least, around £20,000 five years after graduation.
  • Even after accounting for differences in students’ background characteristics and prior attainment, graduates from Russell Group universities have the highest earnings. Overall, graduates of Russell Group universities have earnings 10-13% higher on average than graduates of other institutions with the same observable characteristics. Graduates of the top 10 universities have earnings at least 14% more than apparently similar graduates of the “average” university. The bottom 20 institutions have graduates who earn 10% less than those from an “average” institution.
  • Students from poorer backgrounds earn considerably less than their peers from richer backgrounds. Independent school students earn around 45% (£10,000) more on average five years after graduation than state-school students from poorer backgrounds. When comparing students with similar prior attainment who attended the same institution and studied the same subject independent school students still earn 8% more.

Some of this large gap in earnings is explained by differences in prior attainment and background characteristics of students, but even after these differences are accounted for, significant gaps in earnings remain.  The writers of the report estimate studying medicine or economics increases earnings five years after graduation by more than 25% (between £6,500 and £8,400 per year) compared to studying biological sciences, history or English.

In addition, some subjects like computing and business, where average earnings don’t look especially high, actually seem to add a lot to earnings once you account for the background and A level grades of the students. So while computing graduates come 14th out of 30 subjects in terms of male earnings (18th for women) they leap up to 4th when taking account of their prior attainment (7th for women). To put it another way, for students with a weaker set of A level grades, studying computing increases the chances of earning a relatively high salary.

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Poor Risk Management & Care Planning Led to CQC Placing Care Home in Special Measures

The Care Quality Commission (CQC) has told Willows Care Home, Chester that they must make improvements to protect the safety and welfare of people they care for. It follows an inspection in April.

The Willows Care Home can accommodate 73 people and at the time of the inspection, 54 people were living at the home. The home had previously been inspected in October 2016 and rated as Requires Improvement.

At this inspection, inspectors found new and repeated breaches of regulations. The domains of safe and well-led were rated Inadequate and for caring, effectiveness and responsiveness we rated the service as Requires Improvement. Overall, Willows care home was rated inadequate and placed into special measures.

Key Findings

  • Inspectors found that people could not be assured that risks to their safety were always fully assessed or kept under review. Risks were not always reduced as much as possible and therefore, the service failed to take reasonable steps to keep people safe. The service had not addressed the concerns raised during this or previous inspection visits undertaken by CQC.
  • Care plans were in place however they were not always updated following any changes to peoples care needs. The care and support of people who lived at the home did not always follow their care plan requirements. This meant that there was a risk that their needs were not fully met.
  • Audits were undertaken but learning was not maximised from the findings of these audits.
  • People were not treated with dignity and respect and this was evident over the course of the inspection.

Debbie Westhead, Deputy Chief Inspector of Adult Social Care in the North, said  “We were concerned with the condition of the environment at the last inspection and it is clear the issues had not been addressed properly. While there were examples of some work, the service had not made the improvements promised by the end of December 2016. Remedial repair work was still required to the fabric of the building for example; there were holes, flaking plaster and torn wallpaper on the walls in the corridors, bathrooms and some bedrooms. Skirting boards, tiles and grouting were also in need of repair.

“Other agencies had highlighted concerns with appropriate foods being offered and the dining experience, yet during our inspection it was evident that swift remedial action had not been taken. Worryingly, this meant that the systems in place to monitor the home and drive improvement were not effective. People were not treated with dignity and respect and this was evident over the course of the inspection.

“The service had a system of audits in place for areas such as infection control, medicines and care plans. However, we found these were not always comprehensive or accurate which meant that risks to people’s health and safety were not identified. For example, weekly medicines audits had been carried out but they did not identify issues with storage.

“This service was a long way to go to become compliant and I have concerns in that the same concerns found at the last inspection had not been addressed. Consequently, the Willows care home has been placed in special measures. The CQC will keep the service under review and If not enough improvement is made we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service.”

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Researching New Book Leaves Author in a Comma!

Martin Greenwood was researching his grandfather’s artwork for a new book about his life when he became seriously ill and was unable to breathe.

He was rushed to hospital and spend six days in a coma.

It turned out that microscopic spores from the century-old documents he was researching were the cause of the mystery illness.

Mr Greenwood’s grandfather, Percy, was a famous entertainer, comedian and artist who lived and worked in the Bradford area in the early 1900s.

When Martin regained consciousness, doctors told him he had suffered an allergic reaction after breathing in the spores which were contained in the 100-year-old papers!

He made a full recover and even went on to finish his book ‘Percy Monkman: An Extraordinary Bradfordian.’

Talking about the experience Mr Greenwood said “When I started to look at them [the papers] I started to realise there was a very good story here.

“It seemed a neat thing to do to put some shape to his life and write a story about it for family and friends, so his memory would be kept alive.

“After Christmas in 2016, I took my grandchildren to the park but I could hardly breathe.

“It came to a head two weeks after that, the first week in the New Year I got to a point where I could hardly breathe, walk, I couldn’t stand.

“Medication wasn’t having much impact and my wife, who is a nurse, called the doctor out and I was whizzed into Warwick Hospital.

“I remember arriving in the hospital and the next memory I’ve got is waking up six days later – I’d been put into an induced coma, I was in intensive care for 11 days and in general ward for another ten days.

“For the rest of 2017 I was writing the book and I was careful about using these documents but from time to time did look at them – I had to really to pick up quotations.

“I’m delighted to have finished the book. It almost killed me but I would say it was worth it!”

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UK Artisan SMEs Report a Rise in Sales

A report by the Royal Mail, focusing on the artisan craft and design sectors, has revealed that two-thirds of retail businesses in these sectors have seen an increase in sales, year on year (by an average of 19%).

Gifts, artwork and jewellery are the most common products sold by UK SME craft and design retailers.  Stationery, children’s clothing and adults’ clothing are also popular products to make and sell in the UK.

The Stats

  • Almost three-quarters (72%) of UK SME craft and design retailers sell via their own website, 69% sell via a marketplace and 41% through social media.
  • Eight in ten (80%) retailers state that selling their products via online channels and marketplaces has helped to increase their sales.
  • 85% feel the design industry is increasingly attracting entrepreneurs.
  • 81% of SMEs in this sector are confident that sales will increase in the next twelve months and 41% intend to list their products on more marketplace sites.
  • Gifts, artwork and jewellery are the most common products sold by UK SME craft and design retailers.
  • 57% of UK SME craft and design retailers sell to overseas customers. 74% of these overseas customers are based in Europe, 45% in The USA and 35% in Asia.
  • 49% export goods and 50% import goods.
  • 63% are aiming to increase their international sales revenue over the next 12 months.
  • 81% of retailers are confident that their sales will continue to increase in the next year.

To grow sales, UK SME craft and design retailers intend to:

  • list their products on more marketplace sites (41%),
  • look for space in another physical store (26%)
  • and use social media (22%).

Over half (52%) are also planning to increase their marketing spend and 34% intend to take advantage of the increased interest in UK exports.

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CQC Review of Liverpool Health & Social Care Joint Working – Lessons to be Learnt

The Care Quality Commission has published its findings following a local system review of Liverpool.

This is one of 20 targeted reviews of local authority areas looking specifically at how people move through the health and social care system, with a focus on how services work together.

The reviews look at how hospitals, community health services, GP practices, care homes and home care agencies work together to provide seamless care for older people living in a local area.

The report found that there was a clear strategic direction for health and social care in Liverpool, focused on the needs of people living in the city and described in the One Liverpool strategy.  However, the CQC did criticise those involved in writing the strategy for not including key stakeholders in the development of the strategy and for roll out being patchy.

  • People were not always seen in the right place, at the right time by the right person; there were inconsistencies in commissioning and provision of services.
  • Local people were not actively enabled to participate in service planning and delivery, and a comprehensive public engagement strategy was needed to facilitate meaningful public involvement in shaping the future direction of the city.
  • People using services and their carers were not always supported to take control in making decisions about their care, although they were keen to do so.
  • A neighbourhood model had been developed to bring together primary, community, mental health and social care services, but this model was not being implemented with a clear and consistent approach. For example GPs were not always participating in multidisciplinary meetings, which meant that older people in Liverpool were not always benefitting from integrated working in the same way.
  • The Liverpool health and social care system is making good progress in relation to technology and shared records, with universal use of the NHS number and considerable investment in shared records systems. Efforts had also been made to digitise domiciliary care, which although a positive step, had a negative impact on community health and social care teams who did not have the compatible mobile technology.

The CQC recognised that Liverpool has faced significant financial and system leadership challenges in recent years and this had been a barrier to effective integrated working. Whilst the CQC found that relationships were improving, between the health and social care sectors, it recommended that those involved continue to strengthen these relationships, embedding joint approaches to working to ensure that outcomes for older people are improved.

Professor Steve Field, Chief Inspector of Primary Care Services, said “Although many older people experience the highest standards of care and support as they move between services in Liverpool, too often this does not happen. For the system to make progress its shared vision for One Liverpool needs to be taken forward in a jointly-owned operational plan involving all system stakeholders – including independent providers, voluntary sector organisations and people who use services and their carers.

“There also needs to be a consistent approach to the neighbourhood model, as our review team found inequity in services available and importantly in the engagement of GP providers with this approach.

“System leaders should work with providers to shape the care market, recognising independent providers and the Voluntary Community and Social Enterprise Sector organisations as partners. The quality of residential and nursing care in the city is poor and must improve. We will continue to work with the local authority, NHS commissioners and the providers themselves to ensure that people get the standard of services they are entitled to expect.”

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