Councils have kept up the high quality of their social care services for adults in the past year, the Care Quality Commission said today (25 November).
Outcomes for local people who use services continued to improve in 2009-10 in key areas such as choice and control, dignity and respect, and health and emotional well-being.
Of the 152 councils responsible for adult social care services in England, 95% (145) were assessed as performing well or excellently – the same proportion as the previous year (when there were 148 councils). However, the number performing excellently has increased by five to 37.
Seven authorities were assessed as “adequate”, and CQC said they needed to improve their performance in all outcome areas. For the seventh year running, no councils were rated “poor”.
CQC chief executive Cynthia Bower said: “About 1.75 million people across England rely on the care arranged for them by their council. The large majority of councils provide good standards of care, whether they run the services themselves or commission them from the private or voluntary sectors. But a few need to improve considerably before they can say they are providing good services for local people.
“Our experience is that good performance is the result of strong leadership and commitment by elected councillors and service managers, working together with a skilled and dedicated workforce.
“They encourage people to be actively involved in shaping their own care packages, and they develop and commission the services that meet people’s individual needs.
“The best-performing councils work closely with health agencies to deliver joined-up care, with joint commissioning and monitoring of services becoming more common. This year partnership working was found to be a key strength in half of councils and an area for improvement in a third.”
The system of performance assessment that has operated since 2002 is changing. From the current year, 2010-11, the councils themselves will take more responsibility for driving and monitoring improvement locally, in line with the Government’s vision for the future of social care.
CQC is assisting in the design of a new system with the Department of Health, the Local Government Group and the Association of Directors of Adult Social Services (ADASS).
Ms Bower said: “Councils have achieved improvement year-on-year since 2002. Now the challenge for them, as we move to a new approach, is to continue to perform at this level and to strive to improve even further. The new system will include ways of focusing on the few councils that were assessed as ‘adequate’. We anticipate this will involve an element of peer assessment by other councils.”
Each council sets the level of need that makes a person eligible to receive funding towards their care. There are four levels of eligibility criteria: ‘critical’, ‘substantial’, ‘moderate’ and ‘low’. In 2009-10 one council raised its eligibility criteria and two lowered theirs. Of the 152 councils, three (2%) set their criteria at critical, 107 (70%) at substantial, 37 (24%) at moderate and five (3%) at low.
Key areas of the 2009-10 (April 2009 to March 2010) assessment were:
Choice and control. Councils should help people to take control of their care support by providing clear information and advice on the care options and funding available, helping them to assess their needs, and providing a broad range of support services. Two more councils are performing excellently in this respect, taking the total to 28, and the number judged to be performing well has gone up from 88 to 102. One council was assessed as poor.
Dignity and respect. Councils should have effective “safeguarding” procedures to co-ordinate the response to cases of abuse or people being at risk of abuse, and they should ensure that people’s dignity and privacy are respected in care services. The number of councils judged to be adequate decreased from 45 to 24, while the number performing well or excellently increased from 101 to 125. But the number of councils performing poorly in this area increased from two to three. Concerns reported to councils under the adult safeguarding system increased by nearly a third, to a total of 103,000 referrals. CQC said this rise was largely the result of an increasing awareness of safeguarding through public information campaigns and closer working between councils and health agencies.
Health and emotional well-being. Councils should provide people with personalised advice, information and support to improve their health and well-being and help them to live independently, with the option of individual budgets and local services that meet a range of needs. The number of councils performing well or excellently in this area increased from 136 in 2008-09 to 148 in 2009-10.
CQC’s report, Performance judgements for adult social services, can be found on its website (from Thursday 25 November) at: /guidanceforprofessionals/councils/annualassessments/annualperformanceassessment2009/10.cfm
Thursday 25 November 2010
Tuesday 9 November 2010
Adult social care services have improved but the market must respond to meet future needs, says CQC
The overview report has been compiled using data on council commissioning patterns, national minimum standards and registration data.
CQC’s analysis is restricted to the regulated adult social care market. This includes care homes, home care (domiciliary) care services, nursing agencies and shared lives schemes. These are schemes that pay a family to accomodate an isolated or under-supported older or disabled person. Shared lives schemes are also used as day support and respite care.
Adult social care services have improved significantly since 2008 but further growth in the market is required to meet future needs, according to a Care Quality Commission (CQC) report published today.
The national analysis of the adult social care market examines capacity, quality and commissioning and has been developed using technical data and discussions with leaders within the sector.
An assessment of the market since 2004, the report is based on the CQC’s responsibilities under the now defunct Care Standards Act (2000), giving a final definitive report on evidence gathered under this legislation.
This data shows that this year, 83 percent of care homes, home care services, nursing agencies and shared lives schemes were rated good or excellent compared to 69percent in 2008.
Other findings include:
-There is stability in provision in the adult social care market but further growth will be needed to meet future needs. Overall, the number of services has increased. Residential care home numbers have fallen but nursing home numbers and home care services have increased. The rise in nursing home provision reflects an increase in the number of people who may have been cared for in hospital but are now living in nursing homes.
-It also reflects that people with complex needs are living longer. Demographic forces mean an increase in the number of services will be required if future demand is to be met. For example, according to research, the number of older disabled people is expected to rise by 108 percent by 2041. The challenge is for providers and commissioners to work together to further develop the market to anticipate future long term care needs.
-People are increasingly being supported to live in their homes. Home care services are increasing. In some parts of the country, such as London, significantly more services are geared towards providing care to people in their homes rather than in residential care. Self-directed support, such as direct payments, is enabling people to design their own home care in new ways. To make sure people can continue to be supported to live independently and in their own homes in the future, NHS and council commissioners need to be able to develop local markets.
-Year-on-year councils are commissioning better care homes and home care services. Comparisons with the quality of care arranged by councils from 2008 and 2009 shows a growing improvement in the numbers of services rated good or excellent. However, there remain considerable regional variations within commissioning.
Data contained in the briefing are reported on the cusp of significant economic change and local markets may experience turbulence in the future, the report adds. For example, fewer publicly funded care home places may put pressure on services. However, the national picture of stability in terms of numbers and quality may disguise significant local and regional variations. For example, in London there are fewer care home places available for the over-65s, including places for those with dementia. However, London also has the highest percentage of people living in homes rated good or excellent.
CQC chief executive Cynthia Bower said: ‘We’re greatly encouraged to see the improvement in quality of adult social care and the growth in levels of provision.
‘However, we acknowledge there remain pockets of poor practice. Where we have concerns about quality we will not hesitate to act swiftly, using our tougher enforcement powers.
‘The pressures of the current economic climate mean it is particularly important for providers and councils to work together to develop local care markets and anticipate future long-term care needs.
‘Policy makers should also ensure future social care strategies encourage capacity building for commissioners to develop markets, which will require innovation in the light of economic and budgetary constraints.’
CQC has introduced a new tougher system of regulation based on registration under the Health and Social Care Act 2008. This brings together all the sections of the health and adult social care sector, which are required to meet the essential standards of safety and quality to be registered. Adult social care providers were registered under this system on 1 October.
CQC’s analysis is restricted to the regulated adult social care market. This includes care homes, home care (domiciliary) care services, nursing agencies and shared lives schemes. These are schemes that pay a family to accomodate an isolated or under-supported older or disabled person. Shared lives schemes are also used as day support and respite care.
Adult social care services have improved significantly since 2008 but further growth in the market is required to meet future needs, according to a Care Quality Commission (CQC) report published today.
The national analysis of the adult social care market examines capacity, quality and commissioning and has been developed using technical data and discussions with leaders within the sector.
An assessment of the market since 2004, the report is based on the CQC’s responsibilities under the now defunct Care Standards Act (2000), giving a final definitive report on evidence gathered under this legislation.
This data shows that this year, 83 percent of care homes, home care services, nursing agencies and shared lives schemes were rated good or excellent compared to 69percent in 2008.
Other findings include:
-There is stability in provision in the adult social care market but further growth will be needed to meet future needs. Overall, the number of services has increased. Residential care home numbers have fallen but nursing home numbers and home care services have increased. The rise in nursing home provision reflects an increase in the number of people who may have been cared for in hospital but are now living in nursing homes.
-It also reflects that people with complex needs are living longer. Demographic forces mean an increase in the number of services will be required if future demand is to be met. For example, according to research, the number of older disabled people is expected to rise by 108 percent by 2041. The challenge is for providers and commissioners to work together to further develop the market to anticipate future long term care needs.
-People are increasingly being supported to live in their homes. Home care services are increasing. In some parts of the country, such as London, significantly more services are geared towards providing care to people in their homes rather than in residential care. Self-directed support, such as direct payments, is enabling people to design their own home care in new ways. To make sure people can continue to be supported to live independently and in their own homes in the future, NHS and council commissioners need to be able to develop local markets.
-Year-on-year councils are commissioning better care homes and home care services. Comparisons with the quality of care arranged by councils from 2008 and 2009 shows a growing improvement in the numbers of services rated good or excellent. However, there remain considerable regional variations within commissioning.
Data contained in the briefing are reported on the cusp of significant economic change and local markets may experience turbulence in the future, the report adds. For example, fewer publicly funded care home places may put pressure on services. However, the national picture of stability in terms of numbers and quality may disguise significant local and regional variations. For example, in London there are fewer care home places available for the over-65s, including places for those with dementia. However, London also has the highest percentage of people living in homes rated good or excellent.
CQC chief executive Cynthia Bower said: ‘We’re greatly encouraged to see the improvement in quality of adult social care and the growth in levels of provision.
‘However, we acknowledge there remain pockets of poor practice. Where we have concerns about quality we will not hesitate to act swiftly, using our tougher enforcement powers.
‘The pressures of the current economic climate mean it is particularly important for providers and councils to work together to develop local care markets and anticipate future long-term care needs.
‘Policy makers should also ensure future social care strategies encourage capacity building for commissioners to develop markets, which will require innovation in the light of economic and budgetary constraints.’
CQC has introduced a new tougher system of regulation based on registration under the Health and Social Care Act 2008. This brings together all the sections of the health and adult social care sector, which are required to meet the essential standards of safety and quality to be registered. Adult social care providers were registered under this system on 1 October.
Friday 5 November 2010
CQC says essential standards of care are being met at Wrightington, Wigan and Leigh NHS Foundation Trust
The Care Quality Commission (CQC) said today (Friday) that essential standards of safety and quality at Wrightington, Wigan and Leigh NHS Foundation Trust are being met. Since 1 April 2010, all NHS care providers have been required by law to be registered with CQC and must show that they are meeting the essential standards. Wrightington, Wigan and Leigh NHS Foundation Trust was registered on 1 April.
This latest review of the trust was triggered by concerns about patient care. This resulted in unannounced visits on 22 September 2010 at two locations - the Royal Albert Edward Infirmary, Wigan and Wrightington Hospital.
“Following a meeting in July that was part of our review of the trust, I authorised an unannounced visit which took into account concerns raised by local people,” says Sue McMillan, CQC Regional Director for the North West. “I was keen that we assess the trust against three specific standards: care and welfare of people who use services, assessing and monitoring the quality of service provision, and complaints.
“The assessment team reported that the trust was meeting all three standards.”
Inspectors visited three wards at the Royal Albert Edward Infirmary: Ince Ward (Cardiology), Swinley Ward (Surgery) and the Acute Stroke Unit (Shevington), and Wards 5 and 6 at Wrightington Hospital. This was to directly observe care, treatment and support, talk with patients about their current experience of the hospital and speak with the staff who work on these wards. CQC concluded that patients receive appropriate care as directed within individual care pathways.
In addition, CQC reviewed the trust’s systems for assessing and monitoring the quality of services it provides. The trust demonstrated it had an appropriate framework of governance in place that gathers, records and evaluates information about the quality and safety of care, treatment, support and outcomes of clinical services. CQC also considered relevant information it holds about the trust received from various other sources.
CQC also reviewed the management of complaints and concluded that the trust has procedures, followed in practice, for receiving and managing complaints which are monitored and reviewed as required. Recent changes to these procedures have been implemented. For example, the Medical Director now meets with all complainants, should their complaint not be resolved within three months of instigation. Although staff clearly understood the trust’s complaints procedure and management of complaints, they do not receive ongoing training in complaints handling.
While CQC was content with the cleanliness and tidiness of the wards it did note that the Stroke Unit at the Royal Albert Edward Infirmary was more disorganised, with a generally cluttered environment. It acknowledged that staff were very busy and at times looked stressed. CQC also noted that this ward has recently undergone organisational changes that have resulted in two ward areas being joined and it is still in a period of transition.
A total of 14 patients and 13 staff across both locations were interviewed. Without exception CQC was informed during discussions with patients, of high levels of satisfaction with the care received. Most staff felt happy with the level and frequency of training available and newly qualified staff felt effectively supported by other colleagues or Ward Managers.
“Following this unannounced visit I am satisfied that the trust is meeting essential standards. I am also reassured that the Chief Executive and the senior management team have an up to date assessment of the day to day running of the wards visited,” says Sue McMillan. “And while there are a few actions the trust has to take in respect of record keeping, tidiness on one ward, and regular complaints management training, we did not deem these sufficiently serious that they warranted compliance action. However, we will continue to monitor progress. Finally, I would like to thank the patients, visitors and staff who provided us with vital evidence during our visit.”
Full report: http://www.cqc.org.uk/publications.cfm?fde_id=16473
This latest review of the trust was triggered by concerns about patient care. This resulted in unannounced visits on 22 September 2010 at two locations - the Royal Albert Edward Infirmary, Wigan and Wrightington Hospital.
“Following a meeting in July that was part of our review of the trust, I authorised an unannounced visit which took into account concerns raised by local people,” says Sue McMillan, CQC Regional Director for the North West. “I was keen that we assess the trust against three specific standards: care and welfare of people who use services, assessing and monitoring the quality of service provision, and complaints.
“The assessment team reported that the trust was meeting all three standards.”
Inspectors visited three wards at the Royal Albert Edward Infirmary: Ince Ward (Cardiology), Swinley Ward (Surgery) and the Acute Stroke Unit (Shevington), and Wards 5 and 6 at Wrightington Hospital. This was to directly observe care, treatment and support, talk with patients about their current experience of the hospital and speak with the staff who work on these wards. CQC concluded that patients receive appropriate care as directed within individual care pathways.
In addition, CQC reviewed the trust’s systems for assessing and monitoring the quality of services it provides. The trust demonstrated it had an appropriate framework of governance in place that gathers, records and evaluates information about the quality and safety of care, treatment, support and outcomes of clinical services. CQC also considered relevant information it holds about the trust received from various other sources.
CQC also reviewed the management of complaints and concluded that the trust has procedures, followed in practice, for receiving and managing complaints which are monitored and reviewed as required. Recent changes to these procedures have been implemented. For example, the Medical Director now meets with all complainants, should their complaint not be resolved within three months of instigation. Although staff clearly understood the trust’s complaints procedure and management of complaints, they do not receive ongoing training in complaints handling.
While CQC was content with the cleanliness and tidiness of the wards it did note that the Stroke Unit at the Royal Albert Edward Infirmary was more disorganised, with a generally cluttered environment. It acknowledged that staff were very busy and at times looked stressed. CQC also noted that this ward has recently undergone organisational changes that have resulted in two ward areas being joined and it is still in a period of transition.
A total of 14 patients and 13 staff across both locations were interviewed. Without exception CQC was informed during discussions with patients, of high levels of satisfaction with the care received. Most staff felt happy with the level and frequency of training available and newly qualified staff felt effectively supported by other colleagues or Ward Managers.
“Following this unannounced visit I am satisfied that the trust is meeting essential standards. I am also reassured that the Chief Executive and the senior management team have an up to date assessment of the day to day running of the wards visited,” says Sue McMillan. “And while there are a few actions the trust has to take in respect of record keeping, tidiness on one ward, and regular complaints management training, we did not deem these sufficiently serious that they warranted compliance action. However, we will continue to monitor progress. Finally, I would like to thank the patients, visitors and staff who provided us with vital evidence during our visit.”
Full report: http://www.cqc.org.uk/publications.cfm?fde_id=16473
Friday 29 October 2010
Regulator recognises progress but calls for further improvement from Mid Staffordshire NHS Foundation Trust
The Care Quality Commission has told Mid Staffordshire NHS Foundation Trust that it must continue to make improvements to meet minimum standards of quality and safety.
In a report published today CQC concludes that services at Stafford Hospital are compliant with five of the 16 essential standards. The report identifies 11 standards where improvement is required.
The Commission says the trust has made considerable progress in the last two years. In some areas its concerns remain only because the improvements still need more time to bed in and for CQC to see the full benefit of those changes.
CQC has given the trust's managers 28 days to provide details of action they will take to achieve compliance with the standards where improvement is needed.
Inspectors will return to the trust to review whether the necessary improvements have been made and to decide whether further action is required.
The CQC team will also work closely with West Midlands Strategic Health Authority, South Staffordshire Primary Care Trust and Monitor to help the trust deliver long term improvements.
Today's report evaluates Stafford Hospital's overall performance against all 16 essential standards of quality and safety. By law, providers of health care services have a legal responsibility to make sure they are meeting all the standards.
Inspectors found that the hospital was fully compliant with standards relating to patient consent, meals, partnership working, keeping people who use services safe from harm and assessing and monitoring services.
But they also identified concerns around management of medicines, staff supervision and appraisals and handling of complaints.
Andrea Gordon, Regional Director of CQC in the West Midlands, said that her staff would continue to keep the trust under close review.
“I am satisfied that hospital is moving in the right direction, but the trust must not relax its efforts to improve. We believe that with the right support the management team at the trust has the capability to make the necessary improvements.
“The trust needs to take action to address the issues we have identified. The law says these are the standards that everyone should be able to expect when they receive care. Providers have a duty to ensure they are compliant – or face the possibility of enforcement action.
“Management of medicines is one of the areas that gives us most concern because there are inconsistencies on the wards and the trust’s own audits point to significant problems which must be addressed. Staff training has improved, but arrangements for regular supervision are still not satisfactory and need urgent attention.
“Handling of complaints is another area where we expect to see significant improvements. The trust’s complaints system is not effective because staff involved in complaints are not fully trained and investigations are not completed as quickly as they should be.
“People who depend on these services need to know that they are safe. If we had an immediate concern, we would step in quickly to protect the public.
"In the meantime we will follow up and monitor the improvements identified in this report, and we will take firm action to ensure that Mid Staffordshire NHS Foundation Trust comes up to standard."
-ends-
Notes to editors:
Today's report identified concerns with the following standards
• Management of medicines
• Supporting workers
• Complaints
• Respecting and involving people who use services
• Care and welfare of people who use services
• Safeguarding people who use services from abuse
• Safety and suitability of premises
• Safety, availability and suitability of equipment
• Requirements relating to workers
• Staffing
• Records.
The report finds that Mid Staffordshire is compliant with the following standards:
• Managing risks around patient consent
• Providing adequate meals
• Strengthening its approach to partnership working
• Keeping people who use services safe from harm
• Assessing and monitoring services.
• Download our latest Review of compliance on Mid Staffordshire: http://www.cqc.org.uk/publications.cfm?fde_id=16457
In a report published today CQC concludes that services at Stafford Hospital are compliant with five of the 16 essential standards. The report identifies 11 standards where improvement is required.
The Commission says the trust has made considerable progress in the last two years. In some areas its concerns remain only because the improvements still need more time to bed in and for CQC to see the full benefit of those changes.
CQC has given the trust's managers 28 days to provide details of action they will take to achieve compliance with the standards where improvement is needed.
Inspectors will return to the trust to review whether the necessary improvements have been made and to decide whether further action is required.
The CQC team will also work closely with West Midlands Strategic Health Authority, South Staffordshire Primary Care Trust and Monitor to help the trust deliver long term improvements.
Today's report evaluates Stafford Hospital's overall performance against all 16 essential standards of quality and safety. By law, providers of health care services have a legal responsibility to make sure they are meeting all the standards.
Inspectors found that the hospital was fully compliant with standards relating to patient consent, meals, partnership working, keeping people who use services safe from harm and assessing and monitoring services.
But they also identified concerns around management of medicines, staff supervision and appraisals and handling of complaints.
Andrea Gordon, Regional Director of CQC in the West Midlands, said that her staff would continue to keep the trust under close review.
“I am satisfied that hospital is moving in the right direction, but the trust must not relax its efforts to improve. We believe that with the right support the management team at the trust has the capability to make the necessary improvements.
“The trust needs to take action to address the issues we have identified. The law says these are the standards that everyone should be able to expect when they receive care. Providers have a duty to ensure they are compliant – or face the possibility of enforcement action.
“Management of medicines is one of the areas that gives us most concern because there are inconsistencies on the wards and the trust’s own audits point to significant problems which must be addressed. Staff training has improved, but arrangements for regular supervision are still not satisfactory and need urgent attention.
“Handling of complaints is another area where we expect to see significant improvements. The trust’s complaints system is not effective because staff involved in complaints are not fully trained and investigations are not completed as quickly as they should be.
“People who depend on these services need to know that they are safe. If we had an immediate concern, we would step in quickly to protect the public.
"In the meantime we will follow up and monitor the improvements identified in this report, and we will take firm action to ensure that Mid Staffordshire NHS Foundation Trust comes up to standard."
-ends-
Notes to editors:
Today's report identified concerns with the following standards
• Management of medicines
• Supporting workers
• Complaints
• Respecting and involving people who use services
• Care and welfare of people who use services
• Safeguarding people who use services from abuse
• Safety and suitability of premises
• Safety, availability and suitability of equipment
• Requirements relating to workers
• Staffing
• Records.
The report finds that Mid Staffordshire is compliant with the following standards:
• Managing risks around patient consent
• Providing adequate meals
• Strengthening its approach to partnership working
• Keeping people who use services safe from harm
• Assessing and monitoring services.
• Download our latest Review of compliance on Mid Staffordshire: http://www.cqc.org.uk/publications.cfm?fde_id=16457
Monday 25 October 2010
New consultation on our registration fees scheme
21 October 2010
We have today launched a new consultation on the fees we charge to providers of health and adult social care services.
The consultation sets out our proposals to simplify our fees to a single scheme for all providers. This scheme will cover our work both in registering providers and monitoring their compliance with essential standards of quality and safety. We hope to launch the scheme in April 2011.
This consultation will run until January next year.
• Read our full press release on the launch of the consultation: http://www.cqc.org.uk/newsandevents/pressreleases.cfm?cit_id=36785&FAArea1=customWidgets.content_view_1&usecache=false
• Download our consultation documents and find out how to take part:
• http://www.cqc.org.uk/yourviews/consultations/registrationfeesscheme.cfm
We have today launched a new consultation on the fees we charge to providers of health and adult social care services.
The consultation sets out our proposals to simplify our fees to a single scheme for all providers. This scheme will cover our work both in registering providers and monitoring their compliance with essential standards of quality and safety. We hope to launch the scheme in April 2011.
This consultation will run until January next year.
• Read our full press release on the launch of the consultation: http://www.cqc.org.uk/newsandevents/pressreleases.cfm?cit_id=36785&FAArea1=customWidgets.content_view_1&usecache=false
• Download our consultation documents and find out how to take part:
• http://www.cqc.org.uk/yourviews/consultations/registrationfeesscheme.cfm
Thursday 14 October 2010
More post offices for dental providers’ CRB checks
The Care Quality Commission (CQC) has worked with the Post Office to increase the number of post offices available to process Criminal Record Bureau (CRB) disclosures for providers of dental services.
The way health services are regulated is changing and as part of that change, providers of dental services need to be registered with the CQC by April next year.
The new system of registration will bring all the different elements of the health and adult social services sectors under a single system, which requires providers to meet new essential standards of quality and safety.
This regulation, as directed by the Health and Social Care Act 2008, means all providers of dental services and their registered managers now require an enhanced CRB check if they don’t already have one.
Many dental providers with an NHS contract should already have an enhanced CRB disclosure, approved by the primary care trust they have a contract with. It is estimated that more than 90 percent of the dental industry has an NHS contract. In these cases, no new CRB disclosure will be needed.
However, providers without a criminal records check now need to present proof of identification at a designated post office in England to obtain their mandatory check.
This can currently be carried out at 27 crown post offices where this service is offered but from 1 November, this network will be expanded to 100 post offices able to offer this service.
CQC director, Linda Hutchinson, said: ‘We have been working closely with The Post Office for some time to increase the number of branches available to dental providers obtaining a CRB check.
‘The majority of providers of NHS dental services are already required to have a CRB check countersigned by their local primary care trust and they just need to declare this on their application form to CQC. These dentists will not need to obtain new checks.
‘Obtaining a CRB check is without doubt in the best interests of patients and their safety.
‘CQC appreciates that applying for registration can be challenging as it’s the first time the dental industry has been subject to this form of regulation. We have been working with the dental sector for some time and have just completed a series of local events where we talked to local providers and listened and responded to concerns and queries.
For more information and a full list of post offices go to www.cqc.org.uk/crb.
The way health services are regulated is changing and as part of that change, providers of dental services need to be registered with the CQC by April next year.
The new system of registration will bring all the different elements of the health and adult social services sectors under a single system, which requires providers to meet new essential standards of quality and safety.
This regulation, as directed by the Health and Social Care Act 2008, means all providers of dental services and their registered managers now require an enhanced CRB check if they don’t already have one.
Many dental providers with an NHS contract should already have an enhanced CRB disclosure, approved by the primary care trust they have a contract with. It is estimated that more than 90 percent of the dental industry has an NHS contract. In these cases, no new CRB disclosure will be needed.
However, providers without a criminal records check now need to present proof of identification at a designated post office in England to obtain their mandatory check.
This can currently be carried out at 27 crown post offices where this service is offered but from 1 November, this network will be expanded to 100 post offices able to offer this service.
CQC director, Linda Hutchinson, said: ‘We have been working closely with The Post Office for some time to increase the number of branches available to dental providers obtaining a CRB check.
‘The majority of providers of NHS dental services are already required to have a CRB check countersigned by their local primary care trust and they just need to declare this on their application form to CQC. These dentists will not need to obtain new checks.
‘Obtaining a CRB check is without doubt in the best interests of patients and their safety.
‘CQC appreciates that applying for registration can be challenging as it’s the first time the dental industry has been subject to this form of regulation. We have been working with the dental sector for some time and have just completed a series of local events where we talked to local providers and listened and responded to concerns and queries.
For more information and a full list of post offices go to www.cqc.org.uk/crb.
Significant improvements at The Heart of England
We have lifted two of the three conditions imposed on The Heart of England NHS Foundation Trust.
The trust’s latest compliance report, released today, shows it has addressed our concerns relating to:
safeguarding people who use services
staffing
We inspected The Heart of England Trust on two separate, unannounced occasions. During these visits, we conducted interviews with staff and patients, and reviewed documentary evidence. The results show that the trust:
provides staff with training around safeguarding
encourages staff to make contact with external agencies to increase their understanding of safeguarding
documents safeguarding issues across the trust
The Heart of England now has until September to meet the third condition, which relates to supporting staff.
The trust’s latest compliance report, released today, shows it has addressed our concerns relating to:
safeguarding people who use services
staffing
We inspected The Heart of England Trust on two separate, unannounced occasions. During these visits, we conducted interviews with staff and patients, and reviewed documentary evidence. The results show that the trust:
provides staff with training around safeguarding
encourages staff to make contact with external agencies to increase their understanding of safeguarding
documents safeguarding issues across the trust
The Heart of England now has until September to meet the third condition, which relates to supporting staff.
Monday 11 October 2010
Criminal Record Bureau (CRB) checks
Under the Health and Social Care Act 2008, all health and adult social care providers as part of their registration with the Care Quality Commission (CQC) are required to undertake an enhanced Criminal Record Bureau (CRB) check.
Since 2006, primary dental care providers with an NHS contract were required to have a CRB disclosure countersigned by the PCT which manages the contract. To avoid duplication, CQC has adopted a policy of accepting PCT countersigned CRBs for primary dental care providers. This means that the majority will not need to obtain a new CRB disclosure in order to register with us. They can declare their current one, countersigned by the PCT.
For providers without an NHS contract, the disclosure must be countersigned by CQC. Registered managers must also obtain a CRB disclosure countersigned by CQC, unless the manager is the same person as the provider and already has a PCT countersigned CRB in that capacity (e.g. one of the partners in a partnership may also take on the role of manager).
In order for CQC to countersign the criminal records check, proof of identity is required. To undertake this arrangement, the Post Office is able to check identities on its behalf. This increases the number of places where this can be completed, making it more convenient for providers.
There are currently 27 national "crown" Post Offices which offer this service. From 1 November 2010, 73 additional offices will ensure a wider network is available to cope with the demand for this mandatory check.
We are constantly reviewing the service and will continue to work with the Post Office to increase the number of offices that offer this service.
Please visit www.cqc.org.uk/crb to find your nearest post office.
For more infomation on CRB and the CQC please go here: http://www.cqc.org.uk/contentdisplay.cfm?widCall1=customWidgets.content_view_1&cit_id=36436
Since 2006, primary dental care providers with an NHS contract were required to have a CRB disclosure countersigned by the PCT which manages the contract. To avoid duplication, CQC has adopted a policy of accepting PCT countersigned CRBs for primary dental care providers. This means that the majority will not need to obtain a new CRB disclosure in order to register with us. They can declare their current one, countersigned by the PCT.
For providers without an NHS contract, the disclosure must be countersigned by CQC. Registered managers must also obtain a CRB disclosure countersigned by CQC, unless the manager is the same person as the provider and already has a PCT countersigned CRB in that capacity (e.g. one of the partners in a partnership may also take on the role of manager).
In order for CQC to countersign the criminal records check, proof of identity is required. To undertake this arrangement, the Post Office is able to check identities on its behalf. This increases the number of places where this can be completed, making it more convenient for providers.
There are currently 27 national "crown" Post Offices which offer this service. From 1 November 2010, 73 additional offices will ensure a wider network is available to cope with the demand for this mandatory check.
We are constantly reviewing the service and will continue to work with the Post Office to increase the number of offices that offer this service.
Please visit www.cqc.org.uk/crb to find your nearest post office.
For more infomation on CRB and the CQC please go here: http://www.cqc.org.uk/contentdisplay.cfm?widCall1=customWidgets.content_view_1&cit_id=36436
Friday 8 October 2010
Nearly 1,000 care homes are without a registered manager, says regulator
The Care Quality Commission (CQC) said today (8 October) that nearly 1,000 residential care homes do not have a registered manager in place, despite this being a requirement of the new Health and Social Care Act 2008.
Although it does not present a direct risk to the safety of residents, care homes without a registered manager may be less able to identify potential concerns and address them quickly, said the commission. It has placed conditions on the operators of all the care homes in question requiring them to put managers in place.
Under the provisions of the Act that came into force from last Friday (1 October), many care homes must have a registered manager who is appropriately experienced and qualified. This was also a requirement under the old legislation, the Care Standards Act 2000.
CQC announced today that so far it had newly registered the care providers operating about 20,000 adult social care service locations under the Health and Social Care Act. Just over 15,000 of these locations are residential care homes. Most of the others are home-care agencies and nurses agencies. However, around 1,000 care homes (operated by more than 500 different providers) had a condition placed on them that they appoint a registered manager by 1 April 2011.
Not all care homes need to have a registered manager – CQC said that registered providers who manage their own services on a day-to-day basis do not need to also register as managers.
Cynthia Bower, CQC’s chief executive, said: “It has been recognised in the care sector for some time that there is a shortage of experienced and qualified managers. While we have been undertaking the enormous task of re-registering thousands of care services, the scale of this has become clearer.
“The lack of a registered manager does not necessarily mean that people are receiving poor care, but we know from experience that care services without leadership can struggle to address any problems that may arise. Good-quality care is led by good management.
“We know that some providers struggle to find suitably qualified people to take on this role. The sector as a whole needs to take a robust approach to seeking solutions to the shortage of registered managers. It cannot be allowed to continue indefinitely.
“We will use our enforcement powers in the best interests of people who use services. If a care provider is genuinely trying to appoint a registered manager and the quality of care is good, it might not be in the service users’ best interests for us to take enforcement action immediately. But if we find that people are being put at risk because there is no registered manager, then we will take action.”
Under the new Act, CQC has registered about 9,400 providers of adult social care (with a total of 20,000 different service locations), and 600 providers of independent healthcare (with 1,500 locations such as hospitals and cosmetic surgery clinics).
A further 600 providers across adult social care and independent healthcare are resubmitting their applications after their original applications were incomplete or it was unclear which registered activities they needed to register for. A further 430 have not yet been asked to apply, because they were registered near the end of the old system under the Care Standards Act 2000 and consequently are the last to transfer to the new one.
A further 1,300 providers have not yet applied for registration. CQC said they included those who had proved difficult to contact, some of whom may no longer be operating; all of them would be followed up to establish whether they needed to register or not.
In addition to the conditions relating to the lack of a registered manager, providers of about 200 adult social care and independent healthcare service locations have had conditions placed on their registration in relation to various other compliance issues.
The names of providers with conditions on their registration will be published in due course, after they have had the opportunity to exercise their legal right to make representations to the commission.
Ms Bower thanked care providers for their co-operation: “This has not been an easy process for providers or for CQC. We were set a very tough challenge by government to get everyone into the new system in a very short space of time. Now we can move onto the crucial and continuing task of monitoring the quality and safety of care across the sector.”
NHS trusts came into registration last April under the new Act, which CQC says is an important step forward in ensuring that people receive joined-up care. It is the first time that healthcare and adult social care services have been regulated under the same legislation and the same essential standards of quality and safety.
CQC has tough enforcement powers to drive improvements where it finds standards are not being met, including issuing a warning notice, carrying out a prosecution, and suspending or even closing a service.
Although it does not present a direct risk to the safety of residents, care homes without a registered manager may be less able to identify potential concerns and address them quickly, said the commission. It has placed conditions on the operators of all the care homes in question requiring them to put managers in place.
Under the provisions of the Act that came into force from last Friday (1 October), many care homes must have a registered manager who is appropriately experienced and qualified. This was also a requirement under the old legislation, the Care Standards Act 2000.
CQC announced today that so far it had newly registered the care providers operating about 20,000 adult social care service locations under the Health and Social Care Act. Just over 15,000 of these locations are residential care homes. Most of the others are home-care agencies and nurses agencies. However, around 1,000 care homes (operated by more than 500 different providers) had a condition placed on them that they appoint a registered manager by 1 April 2011.
Not all care homes need to have a registered manager – CQC said that registered providers who manage their own services on a day-to-day basis do not need to also register as managers.
Cynthia Bower, CQC’s chief executive, said: “It has been recognised in the care sector for some time that there is a shortage of experienced and qualified managers. While we have been undertaking the enormous task of re-registering thousands of care services, the scale of this has become clearer.
“The lack of a registered manager does not necessarily mean that people are receiving poor care, but we know from experience that care services without leadership can struggle to address any problems that may arise. Good-quality care is led by good management.
“We know that some providers struggle to find suitably qualified people to take on this role. The sector as a whole needs to take a robust approach to seeking solutions to the shortage of registered managers. It cannot be allowed to continue indefinitely.
“We will use our enforcement powers in the best interests of people who use services. If a care provider is genuinely trying to appoint a registered manager and the quality of care is good, it might not be in the service users’ best interests for us to take enforcement action immediately. But if we find that people are being put at risk because there is no registered manager, then we will take action.”
Under the new Act, CQC has registered about 9,400 providers of adult social care (with a total of 20,000 different service locations), and 600 providers of independent healthcare (with 1,500 locations such as hospitals and cosmetic surgery clinics).
A further 600 providers across adult social care and independent healthcare are resubmitting their applications after their original applications were incomplete or it was unclear which registered activities they needed to register for. A further 430 have not yet been asked to apply, because they were registered near the end of the old system under the Care Standards Act 2000 and consequently are the last to transfer to the new one.
A further 1,300 providers have not yet applied for registration. CQC said they included those who had proved difficult to contact, some of whom may no longer be operating; all of them would be followed up to establish whether they needed to register or not.
In addition to the conditions relating to the lack of a registered manager, providers of about 200 adult social care and independent healthcare service locations have had conditions placed on their registration in relation to various other compliance issues.
The names of providers with conditions on their registration will be published in due course, after they have had the opportunity to exercise their legal right to make representations to the commission.
Ms Bower thanked care providers for their co-operation: “This has not been an easy process for providers or for CQC. We were set a very tough challenge by government to get everyone into the new system in a very short space of time. Now we can move onto the crucial and continuing task of monitoring the quality and safety of care across the sector.”
NHS trusts came into registration last April under the new Act, which CQC says is an important step forward in ensuring that people receive joined-up care. It is the first time that healthcare and adult social care services have been regulated under the same legislation and the same essential standards of quality and safety.
CQC has tough enforcement powers to drive improvements where it finds standards are not being met, including issuing a warning notice, carrying out a prosecution, and suspending or even closing a service.
Thursday 7 October 2010
Breaches found at Scarborough and North East Yorkshire Trust
We have published two reports revealing serious concerns at Scarborough and North East Yorkshire Healthcare NHS Trust.
The reports show Bridlington Hospital is only compliant with six of our 16 essential standards, whilst Scarborough Hospital is compliant with just one.
Our concerns relate to:
• staffing levels
• buildings and maintenance
• patient records
• safeguarding arrangements
• systems for assessing and monitoring service quality
The trust has, however, complied with the following conditions to:
• complete a full risk assessment of its premises and put plans in place to make improvements to the environment
• employ more medical records staff
We have given the trust 14 days to produce plans on how it intends to comply with all our standards. Scarborough and North East Yorkshire faces tougher enforcement action if it does not address our concerns.
Read our press release: http://www.cqc.org.uk/newsandevents/pressreleases.cfm?cit_id=36747&FAArea1=customWidgets.content_view_1&usecache=false
The reports show Bridlington Hospital is only compliant with six of our 16 essential standards, whilst Scarborough Hospital is compliant with just one.
Our concerns relate to:
• staffing levels
• buildings and maintenance
• patient records
• safeguarding arrangements
• systems for assessing and monitoring service quality
The trust has, however, complied with the following conditions to:
• complete a full risk assessment of its premises and put plans in place to make improvements to the environment
• employ more medical records staff
We have given the trust 14 days to produce plans on how it intends to comply with all our standards. Scarborough and North East Yorkshire faces tougher enforcement action if it does not address our concerns.
Read our press release: http://www.cqc.org.uk/newsandevents/pressreleases.cfm?cit_id=36747&FAArea1=customWidgets.content_view_1&usecache=false
Wednesday 6 October 2010
Most conditions lifted on Milton Keynes’ licence
Conditions were originally imposed on Milton Keynes Hospital’s licence in response to concerns over its maternity services.
We found that the trust was not meeting four of our essential standards of quality and safety, and was required to make a series of improvements.
The report published today, shows that the trust has made significant changes to its maternity services, and is now better placed to cope with peaks in demand.
The trust has complied with conditions requiring:
• a revised action plan to address outstanding recommendations made by the Healthcare Commission in 2008.
• a new system that allows midwives to assess and monitor the quality of services provided by the maternity department.
• a revised audit programme that takes into account incidents and complaints.
• a clinical governance system to assess and monitor the quality of service provision across all services.
• that serious incidents and risks are reported to the board and healthcare governance committee.
• that midwives recruited since 1 January 2010 be given comprehensive training in promoting normal births, local maternity policies and procedures and escalation procedures.
• that recommendations made by the Oxford Deanery be reviewed.
We will return to Milton Keynes later in the year to ensure the remaining conditions are met, and we will be prepared to take further action if the trust has not demonstrated compliance with our standards.
We found that the trust was not meeting four of our essential standards of quality and safety, and was required to make a series of improvements.
The report published today, shows that the trust has made significant changes to its maternity services, and is now better placed to cope with peaks in demand.
The trust has complied with conditions requiring:
• a revised action plan to address outstanding recommendations made by the Healthcare Commission in 2008.
• a new system that allows midwives to assess and monitor the quality of services provided by the maternity department.
• a revised audit programme that takes into account incidents and complaints.
• a clinical governance system to assess and monitor the quality of service provision across all services.
• that serious incidents and risks are reported to the board and healthcare governance committee.
• that midwives recruited since 1 January 2010 be given comprehensive training in promoting normal births, local maternity policies and procedures and escalation procedures.
• that recommendations made by the Oxford Deanery be reviewed.
We will return to Milton Keynes later in the year to ensure the remaining conditions are met, and we will be prepared to take further action if the trust has not demonstrated compliance with our standards.
Wednesday 29 September 2010
Care homes closed to protect residents’ safety
We have closed 34 care homes and eight care agencies over the past 12 months to protect residents’ safety. These closures took place in the run up to the full licensing of all health and adult social care providers on the 1 October.
Six of these providers closed after we issued legal notices, whilst the others closed following our enforcement action.
Reasons for closures included:
• verbal and psychological abuse of residents
• medicines not being managed safely
• lack of medical and nursing care
• illegal staff members
• poor sanitary conditions
• lack of staff training
Residents at these services have now been moved to other care homes with better standards.
These closures only represent a small fraction of the 24,000 services in England. The majority of care homes and agencies provide good care and respond positively to areas where they should improve.
Care homes and agencies are now regulated under The Health and Social Care Act 2008, which comes into force on 1 October. The act introduces new essential standards of quality and safety that everyone can expect when they receive care.
The new system will, for the first time, bring the NHS, independent health care and social care providers under the same inspection regime and standards. Our range of enforcement powers include on-the-spot fines, warning notices, suspension of registration, prosecution and closure.
Six of these providers closed after we issued legal notices, whilst the others closed following our enforcement action.
Reasons for closures included:
• verbal and psychological abuse of residents
• medicines not being managed safely
• lack of medical and nursing care
• illegal staff members
• poor sanitary conditions
• lack of staff training
Residents at these services have now been moved to other care homes with better standards.
These closures only represent a small fraction of the 24,000 services in England. The majority of care homes and agencies provide good care and respond positively to areas where they should improve.
Care homes and agencies are now regulated under The Health and Social Care Act 2008, which comes into force on 1 October. The act introduces new essential standards of quality and safety that everyone can expect when they receive care.
The new system will, for the first time, bring the NHS, independent health care and social care providers under the same inspection regime and standards. Our range of enforcement powers include on-the-spot fines, warning notices, suspension of registration, prosecution and closure.
Condition lifted at Heatherwood and Wexham Park Hospitals
We have removed a condition on Heatherwood and Wexham Park’s licence following significant improvements to the way it monitors medical equipment.
Our inspectors conducted interviews and checked equipment at the following locations:
• Ascot Birthing Centre at Heatherwood Hospital
• the A&E and coronary care units at Wexham Park Hospital in Slough
The results of the visits show that the trust has now:
• introduced systems to maintain, replace and repair older equipment
• established new committees and equipment co-ordinators to address risks
The trust now has one final condition remaining on its licence, relating to the way it assesses and monitors the quality of its services.
We have given Heatherwood and Wexham Park until 30 October to ensure they meet this condition.
Find out more
• Download the Review of compliance : http://www.cqc.org.uk/publications.cfm?fde_id=16256
Our inspectors conducted interviews and checked equipment at the following locations:
• Ascot Birthing Centre at Heatherwood Hospital
• the A&E and coronary care units at Wexham Park Hospital in Slough
The results of the visits show that the trust has now:
• introduced systems to maintain, replace and repair older equipment
• established new committees and equipment co-ordinators to address risks
The trust now has one final condition remaining on its licence, relating to the way it assesses and monitors the quality of its services.
We have given Heatherwood and Wexham Park until 30 October to ensure they meet this condition.
Find out more
• Download the Review of compliance : http://www.cqc.org.uk/publications.cfm?fde_id=16256
Tuesday 28 September 2010
Condition lifted at West London Mental Health
We have today lifted one of the three conditions imposed on West London Mental Health Trust.
Under the Mental Health Act (MHA), patients’ detention papers must be reviewed regularly to ensure their rights and needs are being met. According to our new report, the trust now has effective systems in place to ensure:
• documents are reviewed within set timescales
• treatment and care are continually reviewed
The report also reveals that the trust has:
• put in place an action plan that records feedback provided by Mental Health Commissioner visits, enabling managers to effectively act on them
• implemented a quarterly care plan audit which is to be reported to the Patient Experience and Recovery Group meeting led by the Head of Nursing
• created current care plans for detained patients, demonstrating that staff are conversing with patients about their condition
However, evidence shows that not all patients have current care plans in place.
We will continue to monitor West London Mental Health to ensure that progress is being made on patients’ care plans, and to check on the progress of the two remaining conditions relating to:
• staffing
• systems to assess and monitor quality and safety of service provision
Find out more
• Download the Review of compliance: http://www.cqc.org.uk/publications.cfm?fde_id=16220
Under the Mental Health Act (MHA), patients’ detention papers must be reviewed regularly to ensure their rights and needs are being met. According to our new report, the trust now has effective systems in place to ensure:
• documents are reviewed within set timescales
• treatment and care are continually reviewed
The report also reveals that the trust has:
• put in place an action plan that records feedback provided by Mental Health Commissioner visits, enabling managers to effectively act on them
• implemented a quarterly care plan audit which is to be reported to the Patient Experience and Recovery Group meeting led by the Head of Nursing
• created current care plans for detained patients, demonstrating that staff are conversing with patients about their condition
However, evidence shows that not all patients have current care plans in place.
We will continue to monitor West London Mental Health to ensure that progress is being made on patients’ care plans, and to check on the progress of the two remaining conditions relating to:
• staffing
• systems to assess and monitor quality and safety of service provision
Find out more
• Download the Review of compliance: http://www.cqc.org.uk/publications.cfm?fde_id=16220
Friday 24 September 2010
Conditions lifted at Basildon, but further improvements required
The removal of the conditions comes after an unannounced inspection in July that looked at how care was given. The inspection also involved interviews with patients, visitors, staff and senior managers.
The results show that the trust has addressed issues concerning:
• setting up appropriate systems for the supervision and appraisal of staff
• providing training to clinical staff who need to identify and manage patients whose health is deteriorating
However, the trust still needs to make further improvements, specifically covering how staff:
• inform patients of their discharge
• deal with violent and abusive behaviour
We will return to Basildon to assess whether its final condition, relating to reducing the risk of patients contracting legionellas, can be lifted.
Find out more
• Read the press release: http://www.cqc.org.uk/newsandevents/pressreleases.cfm?cit_id=36665&FAArea1=customWidgets.content_view_1&usecache=false
• Download the Review of compliance: http://www.cqc.org.uk/publications.cfm?fde_id=16202
The results show that the trust has addressed issues concerning:
• setting up appropriate systems for the supervision and appraisal of staff
• providing training to clinical staff who need to identify and manage patients whose health is deteriorating
However, the trust still needs to make further improvements, specifically covering how staff:
• inform patients of their discharge
• deal with violent and abusive behaviour
We will return to Basildon to assess whether its final condition, relating to reducing the risk of patients contracting legionellas, can be lifted.
Find out more
• Read the press release: http://www.cqc.org.uk/newsandevents/pressreleases.cfm?cit_id=36665&FAArea1=customWidgets.content_view_1&usecache=false
• Download the Review of compliance: http://www.cqc.org.uk/publications.cfm?fde_id=16202
Tuesday 21 September 2010
Two conditions removed on Sherwood Forest’s licence
The two conditions were imposed on the trust after we found that it had not investigated concerns raised in the Integrated Critical Care Unit (ICCU) at King’s Mill Hospital. This then indicated that the trust did not have an effective system to assess and monitor care.
Following an unannounced inspection in August, we found that King’s Mill Hospital now:
• holds weekly clinical governance meetings to assess effectiveness and risk management
• has developed a monitoring tool to measure the progress of care
• has set up a communications board to discuss incidents and near misses
Additionally, relatives of patients who were being treated in the ICCU provided positive feedback about the care they had seen.
We also found that the trust as a whole now ensures effective systems to assess and monitor all its services:
• All departments across the hospital have a lead clinician for clinical governance, and each directorate reports to the trust-wide clinical governance committee.
• Systems are in place to monitor the quality and safety of services to ensure action is taken when risks are identified.
• Accidents are reviewed and analysed, and results are communicated to staff.
• Mortality data is monitored, and the results are used to improve outcomes for patients.
We also received evidence that the staff take part in surveys, meetings and other forums where they are able to make their views heard.
Find out more
• Read the press release: http://www.cqc.org.uk/newsandevents/pressreleases.cfm?cit_id=36641&FAArea1=customWidgets.content_view_1&usecache=false
Following an unannounced inspection in August, we found that King’s Mill Hospital now:
• holds weekly clinical governance meetings to assess effectiveness and risk management
• has developed a monitoring tool to measure the progress of care
• has set up a communications board to discuss incidents and near misses
Additionally, relatives of patients who were being treated in the ICCU provided positive feedback about the care they had seen.
We also found that the trust as a whole now ensures effective systems to assess and monitor all its services:
• All departments across the hospital have a lead clinician for clinical governance, and each directorate reports to the trust-wide clinical governance committee.
• Systems are in place to monitor the quality and safety of services to ensure action is taken when risks are identified.
• Accidents are reviewed and analysed, and results are communicated to staff.
• Mortality data is monitored, and the results are used to improve outcomes for patients.
We also received evidence that the staff take part in surveys, meetings and other forums where they are able to make their views heard.
Find out more
• Read the press release: http://www.cqc.org.uk/newsandevents/pressreleases.cfm?cit_id=36641&FAArea1=customWidgets.content_view_1&usecache=false
Thursday 16 September 2010
Care regulator tells Devon Partnership NHS Trust to improve or face formal enforcement action
CQC inspectors find mental health trust failed to address all concerns raised by investigation into care and treatment of patients.
The Care Quality Commission has told Devon Partnership NHS Trust that it must improve its systems of staff supervision and appraisal - or face the prospect of formal enforcement action.
When CQC introduced a new registration system in April, Devon Partnership NHS trust was one of 22 NHS organisations that were registered with conditions because they were not meeting essential standards of quality and safety.
Devon Partnership NHS Trust had been subject to an in-depth investigation by CQC, which found that the trust’s failure to supervise and appraise staff had led to serious concerns about the inappropriate administration of medicines in one unit.
Today CQC has published its findings on progress made by the trust to meet the condition on its licence:
• The registered provider must ensure that there are systems in place by 31 March 2010 for the supervision and appraisal of staff and for the keeping of proper records of that supervision and appraisal. Evidence must be available to demonstrate this from 1 April 2010.
Inspectors made two unannounced visits in June to older people’s mental health units at Abbotsvale in Bideford and St John’s Court in Exmouth. They spoke to people who use services, and to relatives and staff.
Inspectors said there had been significant improvements since the investigation. These include higher staffing levels, changes to the environment to improve privacy and dignity for patients and safety improvements in the management of medicines and in end of life care.
However, CQC said the trust had failed to make all the improvements to supervision and appraisal of staff that were required under the condition.
It said that while arrangements for routine supervision have improved, the trust’s own records show that only 22% of their staff had been appraised in the previous nine months. Almost all staff working in older peoples mental health services interviewed by inspectors reported they had not received supervision or an appraisal in the last 12 months.
The regulator has demanded that the trust provides detailed plans within 28 days, outlining how it will implement all necessary improvements. CQC warned that if the improvements are not made, the next step is legal enforcement action.
CQC has also required detailed plans in relation to its concerns with nine other essential standards of quality and safety. Inspectors identified concerns with record-keeping, missing documentation, assessments which did not reflect individual people’s needs or preferences, limited choices of food, incomplete knowledge of safeguarding processes, and poorly-completed care plans.
CQC will closely review the trust’s plans and inspectors will return to the trust later in the year to undertake a full review of all 16 standards of quality and safety to check that improvements are made.
Ian Biggs, Regional Director of CQC in the South West said the regulator would take a flexible, but tough approach to using its new enforcement powers, which start with a warning notice and escalate to fines, prosecution, restrictions on activities or in extreme cases, closure.
He said: “In taking any kind of enforcement action our main consideration is the need to drive improvements which will benefit people who use services.
“We know that the problems over the inappropriate use of medicines in the Harbourne Unit stemmed from a history of inadequate supervision of staff, which allowed years of poor practice to go unchallenged. It was only when concerns were raised in 2008 that the trust managers intervened.
“If doctors and nurses aren't being properly supervised and supported, this can have a significant effect on the quality of care that people experience.
“Throughout this report, we have identified many different ways in which Devon’s services for older people have improved recently. It is clear that the staff have made real progress in a wide range of areas, from management of medicines to layout of wards facilities as well as day-to-day care.
“For this reason it is all the more disappointing that the trust has not taken the action which all agreed was required at the time of registration in April.
“We are now giving notice to the trust, as well as to the South West strategic health authority and to NHS Devon who commission their services, that we are on the verge of legal enforcement action. It is a decision we do not reach lightly.”
The Care Quality Commission has told Devon Partnership NHS Trust that it must improve its systems of staff supervision and appraisal - or face the prospect of formal enforcement action.
When CQC introduced a new registration system in April, Devon Partnership NHS trust was one of 22 NHS organisations that were registered with conditions because they were not meeting essential standards of quality and safety.
Devon Partnership NHS Trust had been subject to an in-depth investigation by CQC, which found that the trust’s failure to supervise and appraise staff had led to serious concerns about the inappropriate administration of medicines in one unit.
Today CQC has published its findings on progress made by the trust to meet the condition on its licence:
• The registered provider must ensure that there are systems in place by 31 March 2010 for the supervision and appraisal of staff and for the keeping of proper records of that supervision and appraisal. Evidence must be available to demonstrate this from 1 April 2010.
Inspectors made two unannounced visits in June to older people’s mental health units at Abbotsvale in Bideford and St John’s Court in Exmouth. They spoke to people who use services, and to relatives and staff.
Inspectors said there had been significant improvements since the investigation. These include higher staffing levels, changes to the environment to improve privacy and dignity for patients and safety improvements in the management of medicines and in end of life care.
However, CQC said the trust had failed to make all the improvements to supervision and appraisal of staff that were required under the condition.
It said that while arrangements for routine supervision have improved, the trust’s own records show that only 22% of their staff had been appraised in the previous nine months. Almost all staff working in older peoples mental health services interviewed by inspectors reported they had not received supervision or an appraisal in the last 12 months.
The regulator has demanded that the trust provides detailed plans within 28 days, outlining how it will implement all necessary improvements. CQC warned that if the improvements are not made, the next step is legal enforcement action.
CQC has also required detailed plans in relation to its concerns with nine other essential standards of quality and safety. Inspectors identified concerns with record-keeping, missing documentation, assessments which did not reflect individual people’s needs or preferences, limited choices of food, incomplete knowledge of safeguarding processes, and poorly-completed care plans.
CQC will closely review the trust’s plans and inspectors will return to the trust later in the year to undertake a full review of all 16 standards of quality and safety to check that improvements are made.
Ian Biggs, Regional Director of CQC in the South West said the regulator would take a flexible, but tough approach to using its new enforcement powers, which start with a warning notice and escalate to fines, prosecution, restrictions on activities or in extreme cases, closure.
He said: “In taking any kind of enforcement action our main consideration is the need to drive improvements which will benefit people who use services.
“We know that the problems over the inappropriate use of medicines in the Harbourne Unit stemmed from a history of inadequate supervision of staff, which allowed years of poor practice to go unchallenged. It was only when concerns were raised in 2008 that the trust managers intervened.
“If doctors and nurses aren't being properly supervised and supported, this can have a significant effect on the quality of care that people experience.
“Throughout this report, we have identified many different ways in which Devon’s services for older people have improved recently. It is clear that the staff have made real progress in a wide range of areas, from management of medicines to layout of wards facilities as well as day-to-day care.
“For this reason it is all the more disappointing that the trust has not taken the action which all agreed was required at the time of registration in April.
“We are now giving notice to the trust, as well as to the South West strategic health authority and to NHS Devon who commission their services, that we are on the verge of legal enforcement action. It is a decision we do not reach lightly.”
Wednesday 15 September 2010
Condition lifted at Peterborough and Stamford
We have lifted the remaining condition imposed on Peterborough and Stamford Hospitals NHS Foundation Trust.
Our latest review found a significant increase in staffing levels at the Peterborough Maternity Unit, ensuring that all women receive care from a registered midwife.
We checked the trust’s compliance through a range of measures including:
• meetings with senior management and staff
• reviewing the results of a survey conducted by the Strategic Health Authority (SHA) on the care women received during labour
The findings show that the trust has:
• successfully recruited a large number of permanent midwifes and additional staff
• put in place a risk escalation process to use when staffing ratios dip below the required level
• created a reserve list to use against future vacancies and bank staff recruitment
• allowed midwives to concentrate on clinical activities by increasing the number of maternity support workers and administration staff on duty
Additionally, according to the interim results from the survey, new mothers are highly satisfied by the care they received. All participants also commented that they received 1 to 1 care from a midwife whilst they were in labour at the maternity unit.
Find out more
• Read the press release:http://www.cqc.org.uk/newsandevents/pressreleases.cfm?cit_id=36625&FAArea1=customWidgets.content_view_1&usecache=false
• Find out about our essential standards:
http://www.cqc.org.uk/aboutcqc/whatwedo/monitoringessentialstandardsofqualityandsafety/whataretheessentialstandardsofqualityandsafety.cfm
Our latest review found a significant increase in staffing levels at the Peterborough Maternity Unit, ensuring that all women receive care from a registered midwife.
We checked the trust’s compliance through a range of measures including:
• meetings with senior management and staff
• reviewing the results of a survey conducted by the Strategic Health Authority (SHA) on the care women received during labour
The findings show that the trust has:
• successfully recruited a large number of permanent midwifes and additional staff
• put in place a risk escalation process to use when staffing ratios dip below the required level
• created a reserve list to use against future vacancies and bank staff recruitment
• allowed midwives to concentrate on clinical activities by increasing the number of maternity support workers and administration staff on duty
Additionally, according to the interim results from the survey, new mothers are highly satisfied by the care they received. All participants also commented that they received 1 to 1 care from a midwife whilst they were in labour at the maternity unit.
Find out more
• Read the press release:http://www.cqc.org.uk/newsandevents/pressreleases.cfm?cit_id=36625&FAArea1=customWidgets.content_view_1&usecache=false
• Find out about our essential standards:
http://www.cqc.org.uk/aboutcqc/whatwedo/monitoringessentialstandardsofqualityandsafety/whataretheessentialstandardsofqualityandsafety.cfm
Tuesday 14 September 2010
Assessments of quality in 2010/11
Earlier this year, we consulted on our proposals for the assessment of quality for health and adult social care in 2010/11.
The consultation provided a high level overview of our planned approach to carrying out periodic reviews and special reviews and studies, and how we plan to publish information about them. We described these three activities as ‘assessments of quality’.
The consultation ran from 2 February to 27 April 2010 and we received over 462 responses to our proposals.
We thank everyone who participated in the consultation, and are encouraged by the many positive responses to our general approach to assessments of quality.
Whilst reviewing the comments, we considered feedback on areas where we can further improve. We have amended our plans for assessments in light of the abolition of the Comprehensive Area Assessment, and the proposals for change in the Government’s white paper, published on 12 July 2010. The changes in the white paper relate to the way the NHS will operate and be regulated.
For more information go here: http://www.cqc.org.uk/newsandevents/newsstories.cfm?FaArea1=customwidgets.content_view_1&cit_id=36599
The consultation provided a high level overview of our planned approach to carrying out periodic reviews and special reviews and studies, and how we plan to publish information about them. We described these three activities as ‘assessments of quality’.
The consultation ran from 2 February to 27 April 2010 and we received over 462 responses to our proposals.
We thank everyone who participated in the consultation, and are encouraged by the many positive responses to our general approach to assessments of quality.
Whilst reviewing the comments, we considered feedback on areas where we can further improve. We have amended our plans for assessments in light of the abolition of the Comprehensive Area Assessment, and the proposals for change in the Government’s white paper, published on 12 July 2010. The changes in the white paper relate to the way the NHS will operate and be regulated.
For more information go here: http://www.cqc.org.uk/newsandevents/newsstories.cfm?FaArea1=customwidgets.content_view_1&cit_id=36599
Community mental health survey results
We have published the results of a survey looking at the experiences of more than 17,000 people who had contact with specialist community mental health services between July and September 2009.
According to the survey, the majority of respondents are generally very positive about the health and social care worker they had seen most recently for their mental health condition. However, the findings also show that some had not been involved as much as they would have liked in some aspects of their care.
The survey covered 66 NHS trusts. Participants included those referred to:
• psychiatric outpatient clinics
• local community mental health teams
• other community-based services
43 per cent of these respondents had their care coordinated under a framework called the Care Programme Approach (CPA). Find out more about the results here: http://www.cqc.org.uk/newsandevents/pressreleases.cfm?cit_id=36623&FAArea1=customWidgets.content_view_1&usecache=false
Key findings
The vast majority of participants said that the health and social care workers listened carefully to them, gave them enough time for discussion and took their views into account. Most people also said that they were treated with respect and dignity, and that they had trust and confidence in the health or social care worker.
However, many reported that they were not as involved in aspects of their care as they would have liked. Some respondents said they would have liked more explanation or more say in their treatment and support.
Find out more
• Read more about the key findings: http://www.cqc.org.uk/newsandevents/pressreleases.cfm?cit_id=36623&FAArea1=customWidgets.content_view_1&usecache=false
• Find out more about the survey: http://www.cqc.org.uk/aboutcqc/howwedoit/involvingpeoplewhouseservices/patientsurveys/communitymentalhealthservices.cfm
• Check how your local NHS Trust scored: http://www.cqc.org.uk/aboutcqc/howwedoit/involvingpeoplewhouseservices/patientsurveys/communitymentalhealthservices/mentalhealthservicessurvey2010a-zlist.cfm
According to the survey, the majority of respondents are generally very positive about the health and social care worker they had seen most recently for their mental health condition. However, the findings also show that some had not been involved as much as they would have liked in some aspects of their care.
The survey covered 66 NHS trusts. Participants included those referred to:
• psychiatric outpatient clinics
• local community mental health teams
• other community-based services
43 per cent of these respondents had their care coordinated under a framework called the Care Programme Approach (CPA). Find out more about the results here: http://www.cqc.org.uk/newsandevents/pressreleases.cfm?cit_id=36623&FAArea1=customWidgets.content_view_1&usecache=false
Key findings
The vast majority of participants said that the health and social care workers listened carefully to them, gave them enough time for discussion and took their views into account. Most people also said that they were treated with respect and dignity, and that they had trust and confidence in the health or social care worker.
However, many reported that they were not as involved in aspects of their care as they would have liked. Some respondents said they would have liked more explanation or more say in their treatment and support.
Find out more
• Read more about the key findings: http://www.cqc.org.uk/newsandevents/pressreleases.cfm?cit_id=36623&FAArea1=customWidgets.content_view_1&usecache=false
• Find out more about the survey: http://www.cqc.org.uk/aboutcqc/howwedoit/involvingpeoplewhouseservices/patientsurveys/communitymentalhealthservices.cfm
• Check how your local NHS Trust scored: http://www.cqc.org.uk/aboutcqc/howwedoit/involvingpeoplewhouseservices/patientsurveys/communitymentalhealthservices/mentalhealthservicessurvey2010a-zlist.cfm
Friday 10 September 2010
Working with children to prevent crime needs better evaluation, say inspectors
The work to turn children away from crime needs to be more focused and to be evaluated better, said independent inspectors who have today published a joint report on youth crime prevention.
Many adults in the criminal justice system began offending in their childhood or early teens at a time when a number of factors made their offending more likely. HM Inspectorate of Constabulary, HM Inspectorate of Probation, the Care Quality Commission and Healthcare Inspectorate Wales examined the approaches to child crime prevention, visiting seven local authorities and examining 75 individual cases where children aged 8 to 13 had been referred for interventions to prevent offending.
Inspectors confirmed that a number of factors in a child’s background can make that individual more likely to offend. The report emphasises that it is difficult to turn some of these children away from crime, but details many examples of prevention work that were having a positive impact on children’s lives.
Inspectors found impressive partnership working and considered approaches to youth crime. However, better coordination and improvement in identifying what works, both locally and nationally, is needed.
Inspectors were pleased to find that:
the quality of key workers was impressive, including their knowledge of and commitment to the children they were working with;
once a child had been identified and assessed, entry onto a prevention programme was generally swift; and
the scope of interventions varied widely and there were some very simple, inexpensive but successful interventions.
Inspectors believe some processes could be refined and better managed, and were concerned that:
there was little co-ordinated evaluation of interventions which have achieved longer term success;
a number of aspects of the underpinning processes and assessment frameworks were overly bureaucratic;
health services were not integrated to the same extent and did not always see themselves as key to prevention; and
the short-term nature of some funding and the different reporting requirements caused concerns about future continuation.
The inspectors said:
“The scope of interventions to prevent youth crime varied widely. Some work was very simple, inexpensive but successful. In some cases, however, it was difficult to understand why a particular intervention was made as it did not appear to address the issues raised at the child’s assessment. The quality of intervention plans ranged from those which were clear, time bound and reviewed to having no plan at all. A significant minority of these plans lacked detail, outcome milestones and an exit strategy. There was little evidence of any local evaluation either of individual interventions or of the longer term outcomes for children. Better evaluation would enable everyone to see what works and improve the ability of practitioners to turn young people away from crime.”
A copy of the report is available at www.hmic.gov.uk or from our website:
http://www.cqc.org.uk/aboutcqc/howwedoit/workinginpartnership/maternity,childrenandyoungpeoplesservices/youthoffendinginspections.cfm
Many adults in the criminal justice system began offending in their childhood or early teens at a time when a number of factors made their offending more likely. HM Inspectorate of Constabulary, HM Inspectorate of Probation, the Care Quality Commission and Healthcare Inspectorate Wales examined the approaches to child crime prevention, visiting seven local authorities and examining 75 individual cases where children aged 8 to 13 had been referred for interventions to prevent offending.
Inspectors confirmed that a number of factors in a child’s background can make that individual more likely to offend. The report emphasises that it is difficult to turn some of these children away from crime, but details many examples of prevention work that were having a positive impact on children’s lives.
Inspectors found impressive partnership working and considered approaches to youth crime. However, better coordination and improvement in identifying what works, both locally and nationally, is needed.
Inspectors were pleased to find that:
the quality of key workers was impressive, including their knowledge of and commitment to the children they were working with;
once a child had been identified and assessed, entry onto a prevention programme was generally swift; and
the scope of interventions varied widely and there were some very simple, inexpensive but successful interventions.
Inspectors believe some processes could be refined and better managed, and were concerned that:
there was little co-ordinated evaluation of interventions which have achieved longer term success;
a number of aspects of the underpinning processes and assessment frameworks were overly bureaucratic;
health services were not integrated to the same extent and did not always see themselves as key to prevention; and
the short-term nature of some funding and the different reporting requirements caused concerns about future continuation.
The inspectors said:
“The scope of interventions to prevent youth crime varied widely. Some work was very simple, inexpensive but successful. In some cases, however, it was difficult to understand why a particular intervention was made as it did not appear to address the issues raised at the child’s assessment. The quality of intervention plans ranged from those which were clear, time bound and reviewed to having no plan at all. A significant minority of these plans lacked detail, outcome milestones and an exit strategy. There was little evidence of any local evaluation either of individual interventions or of the longer term outcomes for children. Better evaluation would enable everyone to see what works and improve the ability of practitioners to turn young people away from crime.”
A copy of the report is available at www.hmic.gov.uk or from our website:
http://www.cqc.org.uk/aboutcqc/howwedoit/workinginpartnership/maternity,childrenandyoungpeoplesservices/youthoffendinginspections.cfm
Wednesday 8 September 2010
Final condition lifted at Surrey and Borders
We have found significant proof of good practice at Surrey and Borders Partnership Trust to lift the final condition imposed on its license.
The condition, which relates to the assessment of patients admitted under the Mental Health Act, required the trust to ensure that all patients were:
• informed about their treatment
• assessed on their capacity to consent to treatment
The trust was also required to document all outcomes relating to patients’ consent.
Our review, carried out in August, involved the inspection of 67 records from a variety of locations. The results showed that the trust has:
• introduced a new form that assesses patients’ ability to give consent and agree to treatment
• achieved 100 per cent compliance in completing the forms within required times
• updated 100 per cent of their patients notes
• effectively communicated to staff how the form should be filled out
We will continue to monitor the improvement of the trust, returning when necessary to check its compliance with the essential standards.
Find out more
• Read the press release: http://www.cqc.org.uk/newsandevents/pressreleases.cfm?cit_id=36581&FAArea1=customWidgets.content_view_1&usecache=false
• Download the Review of compliance: http://www.cqc.org.uk/publications.cfm?fde_id=16064
The condition, which relates to the assessment of patients admitted under the Mental Health Act, required the trust to ensure that all patients were:
• informed about their treatment
• assessed on their capacity to consent to treatment
The trust was also required to document all outcomes relating to patients’ consent.
Our review, carried out in August, involved the inspection of 67 records from a variety of locations. The results showed that the trust has:
• introduced a new form that assesses patients’ ability to give consent and agree to treatment
• achieved 100 per cent compliance in completing the forms within required times
• updated 100 per cent of their patients notes
• effectively communicated to staff how the form should be filled out
We will continue to monitor the improvement of the trust, returning when necessary to check its compliance with the essential standards.
Find out more
• Read the press release: http://www.cqc.org.uk/newsandevents/pressreleases.cfm?cit_id=36581&FAArea1=customWidgets.content_view_1&usecache=false
• Download the Review of compliance: http://www.cqc.org.uk/publications.cfm?fde_id=16064
Thursday 26 August 2010
Registration support for providers of dental services
The Care Quality Commission (CQC) is extending its national contact centre’s opening hours and publishing new guidance on registration to help support primary dental providers preparing to apply for registration under new legislation.
The Newcastle-based centre will now open from 8.30am to 8pm Monday to Thursday, from 8.30am to 5.30pm on Friday and from 8am to 4pm on Saturdays.
CQC has also issued new guidance for the providers of primary dental services, which is available on its website or in hard copy from the national contact centre (NCC) on 03000 616161.
The new guidance provides more information on the application process, which has been refined following a series of pilot projects. CQC is expecting applications
from more than 8,500 providers.
Providers of dental services will soon start applying for registration with CQC with all providers to be registered from 1 April 2011.
Providers only need to apply for registration once. Due to an expected large amount of applications, providers will be put into groups with each group given an application window within which to apply. Services will be registered against the new essential standards of quality and safety that apply across the care sector.
The new system focuses on outcomes, the experiences CQC expects people to have, rather than on policies and processes. The aim of registration is that people can expect services to meet essential standards of quality, to protect their safety and to respect their dignity and rights wherever care is provided, wherever they live.
CQC director, Linda Hutchinson, said: ‘‘We appreciate that this type of regulation is very new to the dental sector and that people will have a lot of questions. We publish regular updates on our website, but we know that some people would prefer to talk things through over the phone. We want to make sure that our helpline is available to answer questions at times that are convenient to dentists, taking their working hours into consideration.
Dr Hutchinson added: ‘We’re also working closely with the General Dental Council to avoid any overlap in our actions and to minimise any potential regulatory burden for providers. Ultimately, our objective is to protect service users and to encourage improvement in the care people receive.’
For further information on the registration process, providers can sign up to CQC’s monthly e-update for health and social care professionals at www.cqc.org.uk/newsandevents/newsletter.cfm and join CQC’s provider reference group, an online community offering the opportunity to engage with our work through a variety of methods including surveys, discussion forms and polls. You can sign up by emailing cqc@nunwood.com.
We will be writing to providers to advise what will happen next and about further action that needs to be taken. For more information go to:
#
or email:enquiries@cqc.org.uk.
The Newcastle-based centre will now open from 8.30am to 8pm Monday to Thursday, from 8.30am to 5.30pm on Friday and from 8am to 4pm on Saturdays.
CQC has also issued new guidance for the providers of primary dental services, which is available on its website or in hard copy from the national contact centre (NCC) on 03000 616161.
The new guidance provides more information on the application process, which has been refined following a series of pilot projects. CQC is expecting applications
from more than 8,500 providers.
Providers of dental services will soon start applying for registration with CQC with all providers to be registered from 1 April 2011.
Providers only need to apply for registration once. Due to an expected large amount of applications, providers will be put into groups with each group given an application window within which to apply. Services will be registered against the new essential standards of quality and safety that apply across the care sector.
The new system focuses on outcomes, the experiences CQC expects people to have, rather than on policies and processes. The aim of registration is that people can expect services to meet essential standards of quality, to protect their safety and to respect their dignity and rights wherever care is provided, wherever they live.
CQC director, Linda Hutchinson, said: ‘‘We appreciate that this type of regulation is very new to the dental sector and that people will have a lot of questions. We publish regular updates on our website, but we know that some people would prefer to talk things through over the phone. We want to make sure that our helpline is available to answer questions at times that are convenient to dentists, taking their working hours into consideration.
Dr Hutchinson added: ‘We’re also working closely with the General Dental Council to avoid any overlap in our actions and to minimise any potential regulatory burden for providers. Ultimately, our objective is to protect service users and to encourage improvement in the care people receive.’
For further information on the registration process, providers can sign up to CQC’s monthly e-update for health and social care professionals at www.cqc.org.uk/newsandevents/newsletter.cfm and join CQC’s provider reference group, an online community offering the opportunity to engage with our work through a variety of methods including surveys, discussion forms and polls. You can sign up by emailing cqc@nunwood.com.
We will be writing to providers to advise what will happen next and about further action that needs to be taken. For more information go to:
#
or email:enquiries@cqc.org.uk.
Friday 6 August 2010
New leaflet on standards you can expect from NHS hospitals
A new leaflet for the general public, 'What standards to expect from the regulation of your NHS hospital' - the first in a series of communications intended for people who use services and the public at large - is now published and is being distributed this week.
We have updated our website under 'Using Care Services' and we will be sending a short news update pointing people to the website to our communciations contacts at LINKs, PALS offices, local councils and voluntary organisations over the coming days.
http://www.cqc.org.uk/usingcareservices/nhshospital.cfm
We have updated our website under 'Using Care Services' and we will be sending a short news update pointing people to the website to our communciations contacts at LINKs, PALS offices, local councils and voluntary organisations over the coming days.
http://www.cqc.org.uk/usingcareservices/nhshospital.cfm
Thursday 5 August 2010
Acting together service
We are looking for experienced organisations to recruit, train and support our network of carers and people who use services, known as Experts by experience:
http://www.cqc.org.uk/aboutcqc/howwedoit/involvingpeoplewhouseservices/socialcareinspections/expertsbyexperience.cfm
Organisations will work with people in Experts by experience throughout a range of
activities, including:
• consultations
• events
• methodology and guidance
• reviews and studies
• site visits to adult social care providers and mental health services
• collecting views from various communities
A strong focus on equality, diversity and human rights, and proof of effective partnerships with local, regional and national organisations is vital.
The closing date is 23 September.
• Download the expression of interest: http://www.cqc.org.uk/publications.cfm?fde_id=16014
http://www.cqc.org.uk/aboutcqc/howwedoit/involvingpeoplewhouseservices/socialcareinspections/expertsbyexperience.cfm
Organisations will work with people in Experts by experience throughout a range of
activities, including:
• consultations
• events
• methodology and guidance
• reviews and studies
• site visits to adult social care providers and mental health services
• collecting views from various communities
A strong focus on equality, diversity and human rights, and proof of effective partnerships with local, regional and national organisations is vital.
The closing date is 23 September.
• Download the expression of interest: http://www.cqc.org.uk/publications.cfm?fde_id=16014
Report shows improvement in safe management of controlled drugs
We have today published a report showing the continued improvement of health and social care organisations in their management of controlled drugs.
Our annual report for 2009 is the third of its kind and details the progress made in implementing regulations brought in following the Shipman Inquiry.
As part of our regulatory work, we were asked to report to government annually on how safer management arrangements are working following the case of Dr Harold Shipman.
The report covers the monitoring of controlled drugs including opioids such as morphine, sleeping tablets, anabolic steroids and growth hormones.
The key recommendations made in the report are that:
• The safe management of controlled drugs should remain a high priority for organisations.
• The Royal Colleges should develop guidance on the appropriate use of opioids and amphetamines for all sectors.
• The Department of Health should revisit requisition regulations and guidance to better capture data in line with the original policy intent.
• Read our full press release on the release of the report
http://www.cqc.org.uk/newsandevents/pressreleases.cfm?cit_id=36526&FAArea1=customWidgets.content_view_1&usecache=false
• Find out more about our work with controlled drugs and download the full report http://www.cqc.org.uk/guidanceforallhealthcarestaff/managingrisk/controlleddrugs/ourrole.cfm
Our annual report for 2009 is the third of its kind and details the progress made in implementing regulations brought in following the Shipman Inquiry.
As part of our regulatory work, we were asked to report to government annually on how safer management arrangements are working following the case of Dr Harold Shipman.
The report covers the monitoring of controlled drugs including opioids such as morphine, sleeping tablets, anabolic steroids and growth hormones.
The key recommendations made in the report are that:
• The safe management of controlled drugs should remain a high priority for organisations.
• The Royal Colleges should develop guidance on the appropriate use of opioids and amphetamines for all sectors.
• The Department of Health should revisit requisition regulations and guidance to better capture data in line with the original policy intent.
• Read our full press release on the release of the report
http://www.cqc.org.uk/newsandevents/pressreleases.cfm?cit_id=36526&FAArea1=customWidgets.content_view_1&usecache=false
• Find out more about our work with controlled drugs and download the full report http://www.cqc.org.uk/guidanceforallhealthcarestaff/managingrisk/controlleddrugs/ourrole.cfm
Thursday 29 July 2010
CQC response to report on paediatric cardiac surgery at John Radcliffe Hospital
The Care Quality Commission said today’s report about paediatric surgery at the John Radcliffe Hospital, raised serious concerns.
Cynthia Bower, CQC’s chief executive, said: “While the report does not say that the failings caused any deaths, I am in no doubt that babies were not receiving care that was as safe as it should be.
“The trust did not handle the safety concerns raised by the surgeon in an effective or transparent way. The delay in notifying the board, strategic health authority and regulator was unacceptable. The clinical governance arrangements to identify and monitor safety risks were not up to scratch. Induction and supervision was clearly poor.”
Ms Bower said CQC was monitoring the trust closely and planned to review standards at the trust as part of its new registration system, which involves ongoing monitoring of quality and safety.
“We will conduct a full review of quality and safety standards across the hospital. This will involve inspections, interviews with patients and staff, and a review of all available data. We won’t hesitate to take action if we find similar problems exist elsewhere in the hospital.”
Background
On 1 April, CQC introduced a tough new licensing system. It registered Oxford Radcliffe NHS Trust without conditions. However, the trust declared concerns relating to:
• insufficient staff on some wards
• poor attendance at staff training
• performance in the cardiac unit (these concerns relate to today’s report)
CQC did not consider that formal conditions were necessary because the trust had good plans in place to address these issues. CQC will check on progress during its upcoming review.
Cynthia Bower, CQC’s chief executive, said: “While the report does not say that the failings caused any deaths, I am in no doubt that babies were not receiving care that was as safe as it should be.
“The trust did not handle the safety concerns raised by the surgeon in an effective or transparent way. The delay in notifying the board, strategic health authority and regulator was unacceptable. The clinical governance arrangements to identify and monitor safety risks were not up to scratch. Induction and supervision was clearly poor.”
Ms Bower said CQC was monitoring the trust closely and planned to review standards at the trust as part of its new registration system, which involves ongoing monitoring of quality and safety.
“We will conduct a full review of quality and safety standards across the hospital. This will involve inspections, interviews with patients and staff, and a review of all available data. We won’t hesitate to take action if we find similar problems exist elsewhere in the hospital.”
Background
On 1 April, CQC introduced a tough new licensing system. It registered Oxford Radcliffe NHS Trust without conditions. However, the trust declared concerns relating to:
• insufficient staff on some wards
• poor attendance at staff training
• performance in the cardiac unit (these concerns relate to today’s report)
CQC did not consider that formal conditions were necessary because the trust had good plans in place to address these issues. CQC will check on progress during its upcoming review.
Tuesday 27 July 2010
Focused on better care - Care Quality Commission first annual report
Please find below a link to the CQC annual report for 2009/10, we report on our work in CQC’s first year of operation – from 1 April 2009 to 31 March 2010.
Visit our online report to look back on the year’s achievements and challenges and watch videos featuring some of the many people who have worked with us to help make sure that everything we do is focused on better care.
. Visit our online annual report:
http://www.cqc.org.uk/newsandevents/newsstories.cfm?FaArea1=customwidgets.content_view_1&cit_id=36498
Visit our online report to look back on the year’s achievements and challenges and watch videos featuring some of the many people who have worked with us to help make sure that everything we do is focused on better care.
. Visit our online annual report:
http://www.cqc.org.uk/newsandevents/newsstories.cfm?FaArea1=customwidgets.content_view_1&cit_id=36498
Significant improvements found in Mid Staffordshire
Improvements in mortality rates, staffing levels, patient experience and responses to concerns have been found in a review of Mid Staffordshire NHS Foundation Trust.
We have today commended the trust for its progress in the year since a critical report was published while also identifying a number of areas where improvements are still needed.
These include some waiting times in A&E and access for nurses to some equipment.
As a part of the review we carried out both announced and unannounced inspections at the trust, speaking to patients, staff and local groups.
Following the positive findings, we will be lifting five of the six conditions placed upon the trust’s registration in April.
These conditions related to:
• Staffing levels.
• Monitoring of the quality of care.
• Equipment training for staff.
• Managing patients in A&E.
• Maintenance of medical equipment.
The final condition, which relates to supervising and appraising workers, has not yet been reviewed and this will be done in August.
• Read our full press release on the review and the lifting of the conditions
http://www.cqc.org.uk/newsandevents/pressreleases.cfm?cit_id=36495&FAArea1=customWidgets.content_view_1&usecache=false
• Find out more about Mid Staffordshire NHS Trust and the concerns over healthcare http://www.cqc.org.uk/usingcareservices/healthcare/concernsabouthealthcare/midstaffordshirenhsfoundationtrust.cfm
We have today commended the trust for its progress in the year since a critical report was published while also identifying a number of areas where improvements are still needed.
These include some waiting times in A&E and access for nurses to some equipment.
As a part of the review we carried out both announced and unannounced inspections at the trust, speaking to patients, staff and local groups.
Following the positive findings, we will be lifting five of the six conditions placed upon the trust’s registration in April.
These conditions related to:
• Staffing levels.
• Monitoring of the quality of care.
• Equipment training for staff.
• Managing patients in A&E.
• Maintenance of medical equipment.
The final condition, which relates to supervising and appraising workers, has not yet been reviewed and this will be done in August.
• Read our full press release on the review and the lifting of the conditions
http://www.cqc.org.uk/newsandevents/pressreleases.cfm?cit_id=36495&FAArea1=customWidgets.content_view_1&usecache=false
• Find out more about Mid Staffordshire NHS Trust and the concerns over healthcare http://www.cqc.org.uk/usingcareservices/healthcare/concernsabouthealthcare/midstaffordshirenhsfoundationtrust.cfm
Monday 26 July 2010
CQC's response to the Dept of Health arm's length bodies review
Cynthia Bower, CQC Chief Executive, has welcomed the publication of the Department of Health’s Arm's Length Bodies review, saying:
“I'm pleased the Department has underlined the importance of integrated health and social care regulation, which we believe can be a real lever to improve the quality of care. The report recognises the hard work CQC has put in to deliver registration of the NHS on time while moving to a more cost effective model.
“In taking on the licensing functions of the HFEA and HTA, we will be looking to preserve the specialist expertise within these bodies. We already regulate a number of sectors where it’s vital to have in-depth knowledge – the rights of people detained under the Mental Health Act, for example – and are confident we can build on what these two bodies have achieved so far.
“We look forward to working with the Department to develop these proposals in more detail, and will be working with Monitor in particular on the single licence for all care providers.”
For the DH's press release and the full report of the Arm's Length Bodies Review, use this link to the DH website:
http://www.dh.gov.uk/en/MediaCentre/Pressreleases/DH_117844
For the DH's consultation paper on expanding Monitor's remit, 'Regulating Healthcare Providers':
http://www.dh.gov.uk/en/MediaCentre/Pressreleases/DH_117848
“I'm pleased the Department has underlined the importance of integrated health and social care regulation, which we believe can be a real lever to improve the quality of care. The report recognises the hard work CQC has put in to deliver registration of the NHS on time while moving to a more cost effective model.
“In taking on the licensing functions of the HFEA and HTA, we will be looking to preserve the specialist expertise within these bodies. We already regulate a number of sectors where it’s vital to have in-depth knowledge – the rights of people detained under the Mental Health Act, for example – and are confident we can build on what these two bodies have achieved so far.
“We look forward to working with the Department to develop these proposals in more detail, and will be working with Monitor in particular on the single licence for all care providers.”
For the DH's press release and the full report of the Arm's Length Bodies Review, use this link to the DH website:
http://www.dh.gov.uk/en/MediaCentre/Pressreleases/DH_117844
For the DH's consultation paper on expanding Monitor's remit, 'Regulating Healthcare Providers':
http://www.dh.gov.uk/en/MediaCentre/Pressreleases/DH_117848
Wednesday 21 July 2010
Registration condition on Surrey and Borders lifted
We have lifted one of two conditions imposed on Surrey and Borders Partnership NHS Foundation Trust.
Two conditions were imposed on the trust earlier this year after we discovered that it was not meeting our essential standards of quality and safety.
We required the trust to take action to ensure that:
· all people who use services have up to date care plans and that staff receive training in the assessment and recording of risk
The trust provided us with evidence to show that it has met the condition before the deadline and applied for the condition to be removed.
Following an inspection in May where we interviewed patients and staff and reviewed documents at six units, we discovered that the trust has:
· put in place monthly record-keeping audits to check on care plans and risk assessments
· designated a nurse to primarily be responsible for auditing the quality of the Care Plan Approach and risk assessments
· organised an audit group to carry out regular inspections of inpatient services including record-keeping, assessments and care plans
· trained all relevant staff in their three-yearly Care Plan Approach and risk training, and will provide them with 10 clinical supervision sessions and an annual appraisal
We will assess whether the trust has met the second condition in the near future.
Find out more
· Download the review of compliance:
http://www.cqc.org.uk/publications.cfm?fde_id=15936
· Read the press release:
http://www.cqc.org.uk/newsandevents/pressreleases.cfm?cit_id=36437&FAArea1=customWidgets.content_view_1&usecache=false
· Read our essential standards of quality and safety:http://www.cqc.org.uk/aboutcqc/whatwedo/monitoringessentialstandardsofqualityandsafety/whataretheessentialstandardsofqualityandsafety.cfm
Two conditions were imposed on the trust earlier this year after we discovered that it was not meeting our essential standards of quality and safety.
We required the trust to take action to ensure that:
· all people who use services have up to date care plans and that staff receive training in the assessment and recording of risk
The trust provided us with evidence to show that it has met the condition before the deadline and applied for the condition to be removed.
Following an inspection in May where we interviewed patients and staff and reviewed documents at six units, we discovered that the trust has:
· put in place monthly record-keeping audits to check on care plans and risk assessments
· designated a nurse to primarily be responsible for auditing the quality of the Care Plan Approach and risk assessments
· organised an audit group to carry out regular inspections of inpatient services including record-keeping, assessments and care plans
· trained all relevant staff in their three-yearly Care Plan Approach and risk training, and will provide them with 10 clinical supervision sessions and an annual appraisal
We will assess whether the trust has met the second condition in the near future.
Find out more
· Download the review of compliance:
http://www.cqc.org.uk/publications.cfm?fde_id=15936
· Read the press release:
http://www.cqc.org.uk/newsandevents/pressreleases.cfm?cit_id=36437&FAArea1=customWidgets.content_view_1&usecache=false
· Read our essential standards of quality and safety:http://www.cqc.org.uk/aboutcqc/whatwedo/monitoringessentialstandardsofqualityandsafety/whataretheessentialstandardsofqualityandsafety.cfm
Tuesday 20 July 2010
Comment from Dame Jo Williams in response to Department of Health’s announcement that she is the government's candidate for CQC chair.
Dame Jo Williams said: “I am absolutely delighted to be the government’s candidate for the post of chair for the Care Quality Commission (CQC).
“I have thoroughly enjoyed the last seven months as interim chair at CQC, and am extremely proud of what we have achieved in that time. We have successfully registered the NHS against a new set of standards, and look forward to rolling this out to all health and adult social care providers over the coming months and years. But I don’t underestimate the challenges ahead.
“I am deeply passionate about continuing to drive improvement to ensure everyone has access to safe, quality services across the country.”
-ends-
Department of Health Press release:
http://www.dh.gov.uk/en/MediaCentre/Pressreleases/DH_117655
“I have thoroughly enjoyed the last seven months as interim chair at CQC, and am extremely proud of what we have achieved in that time. We have successfully registered the NHS against a new set of standards, and look forward to rolling this out to all health and adult social care providers over the coming months and years. But I don’t underestimate the challenges ahead.
“I am deeply passionate about continuing to drive improvement to ensure everyone has access to safe, quality services across the country.”
-ends-
Department of Health Press release:
http://www.dh.gov.uk/en/MediaCentre/Pressreleases/DH_117655
Dame Jo Williams' reaction to new funding commission appointment
Reacting to Health Secretary Andrew Lansley's announcement today that she has been asked to sit on the new Commission on the Funding of Care and Support, Dame Jo Williams, acting Chair of the Care Quality Commission, said:
"I am very pleased to have this opportunity to help shape a way forward on one of the most significant issues facing society.
"I hope to be able to contribute towards finding an equitable and sustainable solution for future generations."
Dame Jo will serve on the new commission for one day a week while continuing her role as CQC's acting chair.
"I am very pleased to have this opportunity to help shape a way forward on one of the most significant issues facing society.
"I hope to be able to contribute towards finding an equitable and sustainable solution for future generations."
Dame Jo will serve on the new commission for one day a week while continuing her role as CQC's acting chair.
Thursday 15 July 2010
Care Quality Commission's investigation into GP out-of-hours provider, Take Care Now, reveals serious failings
· Take Care Now (TCN) did not act on previous warnings about the use of diamorphine prior to the death of David Gray, and systemic failings were not addressed
· The five primary care trusts (PCTs) that used TCN had limited understanding of the service and did not monitor performance adequately
The Care Quality Commission (CQC) today (Thursday) published its report into the GP out-of-hours provider, Take Care Now (TCN).
The regulator’s investigation was triggered by the tragic case of Mr David Gray, a patient killed by an overdose of 100mg diamorphine in February 2008. The drug was administered by Dr Ubani, an out-of-hours doctor from Germany employed by TCN.
Dr Ubani has since been struck off the General Medical Council (GMC) register and is no longer permitted to practise in the UK.
CQC looked in-depth at TCN’s out-of-hours service to assess its performance dating back to April 2007. It also assessed whether lessons had been learned and action taken following the death of Mr Gray.
As part of its investigation, CQC considered how the five PCTs that used TCN’s out-of-hours services monitored the quality of the service being provided.
CQC’s report shows that prior to the death of Mr Gray, TCN did not take sufficient action to ensure the safe use of diamorphine. This is despite a senior clinician warning TCN managers that it “was only a matter of time before a patient is killed” due to an overdose of the drug.
The warning followed two non-fatal overdoses of diamorphine, which occurred in Suffolk in the year before Mr Gray’s death (April and August 2007). In both cases the drug was administered by doctors from Germany, where diamorphine is not routinely used. Clinicians suggested changes to prevent future overdoses, but these were not implemented.
Today’s report highlights further systemic failings by TCN. CQC published evidence that:
· staffing levels were potentially unsafe. Unfilled shifts and lack of clinical cover could have compromised the care of patients. There were occasions when one nurse was the only clinical cover for 70 miles.
· TCN failed to investigate, act upon and learn from serious incidents. This included the two previous overdoses of diamorphine.
· reporting of activity to the PCTs was not clear and transparent. “Double counting” of some patients would have given the impression that TCN was treating more patients and could have affected contract negotiations with the PCTs.
· local GPs were not confident in the service provided by TCN. Fifty per cent of GPs surveyed by CQC said the ability of the organisation to provide clinical care in people’s home was “poor” or “very poor”.
· TCN grew rapidly, taking on more contracts with PCTs, but apparently without the clinical governance in place to ensure the quality of its services.
CQC reviewed the commissioning and monitoring role of the five PCTs that purchased out-of-hours services from TCN: NHS Cambridgeshire, NHS Great Yarmouth and Waveney, NHS South West Essex, NHS Suffolk and NHS Worcestershire.
CQC found that:
· NHS Cambridgeshire took significant steps to monitor TCN's services after the death of Mr Gray.
· Out-of-hours services were a low priority for PCTs, reflecting the national position at the time.
· Those responsible for monitoring the contract with TCN had a limited understanding of the service. They did not fully understand the performance reports or the national quality requirements (NQRs)
· Changes to services that could have had significant implications for patients were often discussed and agreed by non-clinical staff
· None of the PCTs had robust arrangements to share information on poorly performing clinicians.
· Cornwall PCT had admitted Dr Ubani to its performers list without requiring proof of language competency and with limited checking of his references. This meant Dr Ubani could work anywhere in the UK. The trust did not formally review how doctors were admitted to the performers list until March this year.
CQC says the PCTs involved have since taken action to improve commissioning and monitoring of out-of-hours services. But it makes national recommendations to all PCTs and out-of-hours providers across the country to ensure a safe and effective service is delivered.
In relation to the two SHAs, NHS East of England and NHS West Midlands, there is no evidence
that they paid specific attention to out-of-hours care, but have since taken significant action to address issues about these services in their regions.
Dame Jo Williams, CQC chairman, said: "Take Care Now failed on many fronts. Not only did it ignore explicit warnings about the use of diamorphine, it failed to address deep-rooted problems across its entire out-of-hours service. This had tragic consequences for Mr Gray.
"Take Care Now is no longer in operation, but the lessons of its failure must resonate across the health service. Around seven million people contact GP out-of-hours services every year - the provider, the primary care trust and individual clinicians all have a responsibility to ensure services are as safe as possible.
"Since the death of Mr Gray, there is no doubt that out-of-hours care is now a high priority on the NHS agenda, and rightfully so. Primary care trusts in particular are now scrutinising the services they commission in greater detail and demanding assurances about safety.
"We hope the family of Mr Gray will take some comfort in knowing that his tragic death has brought about significant change in the way out-of-hours services are delivered and monitored.
Commenting about potential changes to government policy on out-of-hours services, Dame Jo added: "The Secretary of State has made it clear that there are changes around the corner. Regardless of what these changes may look like, the lessons are clear - the competency of overseas doctors must be properly tested; serious incidents must be properly investigated and quality of care must be monitored closely."
From April 2012, companies providing GP out-of-hours services must be registered with CQC in order to legally provide services. The new registration system brings the NHS, independent healthcare and adult social care under a single set of essential standards of quality and safety.
CQC says it will take the findings of its investigation into TCN, and other external reviews of out-of-hours services, into account when making decisions about how it will regulate out-of-hours providers in line with the new standards.
Find out more
· Full summary of findings http://www.cqc.org.uk/publications.cfm?fde_id=15914
· Briefing notes http://www.cqc.org.uk/publications.cfm?fde_id=15915
· Report 1 http://www.cqc.org.uk/publications.cfm?fde_id=15916
· Report 2 http://www.cqc.org.uk/publications.cfm?fde_id=15917
· Report 3 http://www.cqc.org.uk/publications.cfm?fde_id=15918
· Appendices http://www.cqc.org.uk/publications.cfm?fde_id=15919
· The five primary care trusts (PCTs) that used TCN had limited understanding of the service and did not monitor performance adequately
The Care Quality Commission (CQC) today (Thursday) published its report into the GP out-of-hours provider, Take Care Now (TCN).
The regulator’s investigation was triggered by the tragic case of Mr David Gray, a patient killed by an overdose of 100mg diamorphine in February 2008. The drug was administered by Dr Ubani, an out-of-hours doctor from Germany employed by TCN.
Dr Ubani has since been struck off the General Medical Council (GMC) register and is no longer permitted to practise in the UK.
CQC looked in-depth at TCN’s out-of-hours service to assess its performance dating back to April 2007. It also assessed whether lessons had been learned and action taken following the death of Mr Gray.
As part of its investigation, CQC considered how the five PCTs that used TCN’s out-of-hours services monitored the quality of the service being provided.
CQC’s report shows that prior to the death of Mr Gray, TCN did not take sufficient action to ensure the safe use of diamorphine. This is despite a senior clinician warning TCN managers that it “was only a matter of time before a patient is killed” due to an overdose of the drug.
The warning followed two non-fatal overdoses of diamorphine, which occurred in Suffolk in the year before Mr Gray’s death (April and August 2007). In both cases the drug was administered by doctors from Germany, where diamorphine is not routinely used. Clinicians suggested changes to prevent future overdoses, but these were not implemented.
Today’s report highlights further systemic failings by TCN. CQC published evidence that:
· staffing levels were potentially unsafe. Unfilled shifts and lack of clinical cover could have compromised the care of patients. There were occasions when one nurse was the only clinical cover for 70 miles.
· TCN failed to investigate, act upon and learn from serious incidents. This included the two previous overdoses of diamorphine.
· reporting of activity to the PCTs was not clear and transparent. “Double counting” of some patients would have given the impression that TCN was treating more patients and could have affected contract negotiations with the PCTs.
· local GPs were not confident in the service provided by TCN. Fifty per cent of GPs surveyed by CQC said the ability of the organisation to provide clinical care in people’s home was “poor” or “very poor”.
· TCN grew rapidly, taking on more contracts with PCTs, but apparently without the clinical governance in place to ensure the quality of its services.
CQC reviewed the commissioning and monitoring role of the five PCTs that purchased out-of-hours services from TCN: NHS Cambridgeshire, NHS Great Yarmouth and Waveney, NHS South West Essex, NHS Suffolk and NHS Worcestershire.
CQC found that:
· NHS Cambridgeshire took significant steps to monitor TCN's services after the death of Mr Gray.
· Out-of-hours services were a low priority for PCTs, reflecting the national position at the time.
· Those responsible for monitoring the contract with TCN had a limited understanding of the service. They did not fully understand the performance reports or the national quality requirements (NQRs)
· Changes to services that could have had significant implications for patients were often discussed and agreed by non-clinical staff
· None of the PCTs had robust arrangements to share information on poorly performing clinicians.
· Cornwall PCT had admitted Dr Ubani to its performers list without requiring proof of language competency and with limited checking of his references. This meant Dr Ubani could work anywhere in the UK. The trust did not formally review how doctors were admitted to the performers list until March this year.
CQC says the PCTs involved have since taken action to improve commissioning and monitoring of out-of-hours services. But it makes national recommendations to all PCTs and out-of-hours providers across the country to ensure a safe and effective service is delivered.
In relation to the two SHAs, NHS East of England and NHS West Midlands, there is no evidence
that they paid specific attention to out-of-hours care, but have since taken significant action to address issues about these services in their regions.
Dame Jo Williams, CQC chairman, said: "Take Care Now failed on many fronts. Not only did it ignore explicit warnings about the use of diamorphine, it failed to address deep-rooted problems across its entire out-of-hours service. This had tragic consequences for Mr Gray.
"Take Care Now is no longer in operation, but the lessons of its failure must resonate across the health service. Around seven million people contact GP out-of-hours services every year - the provider, the primary care trust and individual clinicians all have a responsibility to ensure services are as safe as possible.
"Since the death of Mr Gray, there is no doubt that out-of-hours care is now a high priority on the NHS agenda, and rightfully so. Primary care trusts in particular are now scrutinising the services they commission in greater detail and demanding assurances about safety.
"We hope the family of Mr Gray will take some comfort in knowing that his tragic death has brought about significant change in the way out-of-hours services are delivered and monitored.
Commenting about potential changes to government policy on out-of-hours services, Dame Jo added: "The Secretary of State has made it clear that there are changes around the corner. Regardless of what these changes may look like, the lessons are clear - the competency of overseas doctors must be properly tested; serious incidents must be properly investigated and quality of care must be monitored closely."
From April 2012, companies providing GP out-of-hours services must be registered with CQC in order to legally provide services. The new registration system brings the NHS, independent healthcare and adult social care under a single set of essential standards of quality and safety.
CQC says it will take the findings of its investigation into TCN, and other external reviews of out-of-hours services, into account when making decisions about how it will regulate out-of-hours providers in line with the new standards.
Find out more
· Full summary of findings http://www.cqc.org.uk/publications.cfm?fde_id=15914
· Briefing notes http://www.cqc.org.uk/publications.cfm?fde_id=15915
· Report 1 http://www.cqc.org.uk/publications.cfm?fde_id=15916
· Report 2 http://www.cqc.org.uk/publications.cfm?fde_id=15917
· Report 3 http://www.cqc.org.uk/publications.cfm?fde_id=15918
· Appendices http://www.cqc.org.uk/publications.cfm?fde_id=15919
Wednesday 14 July 2010
CQC lifts registration conditions at Northern Lincolnshire and Goole
· Download the review of compliance http://www.cqc.org.uk/publications.cfm?fde_id=15912
Conditions were imposed on the trust after an inspection of the A&E department at the Diana Princess of Wales Hospital in Grimsby.
Inspectors found that patients who were admitted to the hospital by ambulance were:
· asked to wait in the corridor before triage (the process of assessment based on patients’ need for immediate medical treatment)
· not always properly assessed
We gave the trust a deadline of 1 April to ensure:
· all ambulance patients are seen by a senior clinician as soon as possible
· the quality of services provided by the A&E department are regularly assessed and monitored
During an unannounced visit in May, we found that the trust had improved the arrangements for patients in the A&E department. The trust had:
· ensured a nurse was responsible for ‘triaging’ patients upon arrival
· set up protocols to ensure faster handover of patients from ambulance to A&E staff · secured funding for a new triage area
· arranged for the board to scrutinise the top 10 risks for each department
· given A&E staff more input when it came to clinical governance
· ensured more incidents were reported
Following the new arrangements, approximately 68% of patients brought in by ambulance were triaged within 15 minutes.
Find out more
· Read the press release http://www.cqc.org.uk/newsandevents/pressreleases.cfm?cit_id=36427&FAArea1=customWidgets.content_view_1&usecache=false
· Read about our essential standards of quality and safety http://www.cqc.org.uk/aboutcqc/whatwedo/monitoringessentialstandardsofqualityandsafety/whataretheessentialstandardsofqualityandsafety.cfm
Conditions were imposed on the trust after an inspection of the A&E department at the Diana Princess of Wales Hospital in Grimsby.
Inspectors found that patients who were admitted to the hospital by ambulance were:
· asked to wait in the corridor before triage (the process of assessment based on patients’ need for immediate medical treatment)
· not always properly assessed
We gave the trust a deadline of 1 April to ensure:
· all ambulance patients are seen by a senior clinician as soon as possible
· the quality of services provided by the A&E department are regularly assessed and monitored
During an unannounced visit in May, we found that the trust had improved the arrangements for patients in the A&E department. The trust had:
· ensured a nurse was responsible for ‘triaging’ patients upon arrival
· set up protocols to ensure faster handover of patients from ambulance to A&E staff · secured funding for a new triage area
· arranged for the board to scrutinise the top 10 risks for each department
· given A&E staff more input when it came to clinical governance
· ensured more incidents were reported
Following the new arrangements, approximately 68% of patients brought in by ambulance were triaged within 15 minutes.
Find out more
· Read the press release http://www.cqc.org.uk/newsandevents/pressreleases.cfm?cit_id=36427&FAArea1=customWidgets.content_view_1&usecache=false
· Read about our essential standards of quality and safety http://www.cqc.org.uk/aboutcqc/whatwedo/monitoringessentialstandardsofqualityandsafety/whataretheessentialstandardsofqualityandsafety.cfm
Tuesday 13 July 2010
Conditions lifted on Mid Essex Services NHS Trust
· Download the review of compliance at Mid Essex Services NHS Trust: http://www.cqc.org.uk/publications.cfm?fde_id=15911
We imposed a condition on the trust’s registration following an inspection in February 2010 which revealed a lack of:
· cleanliness
· staff training into infection control
We required the trust to take urgent action to ensure cleanliness and safety for all its patients and staff.
In May we made an unannounced visit where we interviewed staff and inspected wards. The inspection revealed significant progress in following appropriate infection control policies.
However, minor improvements can still be made in areas concerning the:
· cleanliness of patients’ rooms
· logging and recording of decontaminated medical equipment such as pillows, mattresses and disposable items
Find out more
· Read the press release:
http://www.cqc.org.uk/newsandevents/pressreleases.cfm?cit_id=36422&FAArea1=customWidgets.content_view_1&usecache=false
· Find out how we monitor essential standards of quality and safety:
http://www.cqc.org.uk/aboutcqc/whatwedo/monitoringessentialstandardsofqualityandsafety.cfm
We imposed a condition on the trust’s registration following an inspection in February 2010 which revealed a lack of:
· cleanliness
· staff training into infection control
We required the trust to take urgent action to ensure cleanliness and safety for all its patients and staff.
In May we made an unannounced visit where we interviewed staff and inspected wards. The inspection revealed significant progress in following appropriate infection control policies.
However, minor improvements can still be made in areas concerning the:
· cleanliness of patients’ rooms
· logging and recording of decontaminated medical equipment such as pillows, mattresses and disposable items
Find out more
· Read the press release:
http://www.cqc.org.uk/newsandevents/pressreleases.cfm?cit_id=36422&FAArea1=customWidgets.content_view_1&usecache=false
· Find out how we monitor essential standards of quality and safety:
http://www.cqc.org.uk/aboutcqc/whatwedo/monitoringessentialstandardsofqualityandsafety.cfm
Monday 12 July 2010
Care Quality Commission response to the government's health white paper
CQC said the white paper confirmed its continued role as the quality regulator for health and adult social care. Under the proposals, the current risk-based regulatory regime will remain largely unchanged.
However, the white paper does set out a number of important changes for CQC.
- HealthWatch England will be established as a new independent consumer champion within CQC
- Providers will have a joint licence overseen by both Monitor and CQC
-The NHS Board will take over assesssment of commissioning
In relation to 'HealthWatch', Ms Bower said: "Anything that gives people more say in how care services are monitored is a good thing. We already work closely with local groups and this will formalise and strengthen that collaboration. There is enormous potential here to share information and get local people even more involved in inspections and assessments. But we want to be clear that HealthWatch should be a separate arm of the regulator. It must be close enough to CQC to influence regulation and share information, but retain enough independence to be a strong voice, constantly challenging on behalf of local people."
Ms Bower added that CQC would begin discussions with Monitor over the joint licensing system.
Ms Bower said: "This year we introduced a tough new licensing system for essential standards of quality and safety. We look forward to working with Monitor to develop a joint licensing regime."
In relation to assessment of commissioning, Ms Bower said: "It's right for the responsibility of assessing commissioning to sit elsewhere, however no doubt we will still contribute a lot of important information. CQC's role is now clearly focussed on getting standards of quality and safety in place across the whole sector."
However, the white paper does set out a number of important changes for CQC.
- HealthWatch England will be established as a new independent consumer champion within CQC
- Providers will have a joint licence overseen by both Monitor and CQC
-The NHS Board will take over assesssment of commissioning
In relation to 'HealthWatch', Ms Bower said: "Anything that gives people more say in how care services are monitored is a good thing. We already work closely with local groups and this will formalise and strengthen that collaboration. There is enormous potential here to share information and get local people even more involved in inspections and assessments. But we want to be clear that HealthWatch should be a separate arm of the regulator. It must be close enough to CQC to influence regulation and share information, but retain enough independence to be a strong voice, constantly challenging on behalf of local people."
Ms Bower added that CQC would begin discussions with Monitor over the joint licensing system.
Ms Bower said: "This year we introduced a tough new licensing system for essential standards of quality and safety. We look forward to working with Monitor to develop a joint licensing regime."
In relation to assessment of commissioning, Ms Bower said: "It's right for the responsibility of assessing commissioning to sit elsewhere, however no doubt we will still contribute a lot of important information. CQC's role is now clearly focussed on getting standards of quality and safety in place across the whole sector."
Wednesday 7 July 2010
Reduced risks to patients at West London Mental Health NHS Trust
Our new report reveals significant improvements at West London Mental Health NHS Trust (WLMHT) to protect patient safety.
Download the follow-up report:
· http://www.cqc.org.uk/publications.cfm?fde_id=15896
Nine recommendations were implemented on WLMHT in July 2009 after a year-long investigation of the Trust. The original report highlighted delays in investigating incidents and a failure to learn from common themes documented in action plans.
This was followed up by an inspection completed in March of this year, involving interviews with people who used services, staff and board members, and a review of documented evidence.
This inspection found that the trust had made improvements in:
· the assessment of physical health care
· the reporting, investigating and communication of risks
· the provision of primary care services
· cleanliness of wards
However, the trust must continue to make progress in:
· care planning
· improving communication between staff and people who use services
· demonstrating that lessons learnt are shared across the whole trust
CQC will continue to monitor the trust to ensure that recommendations are met. It will carry out a review of commissioning services later this year.
Find out more:
Read the original report
· http://www.cqc.org.uk/_db/_documents/Investigation_into_West_London_Mental_Health_NHS_Trust_FINAL_200907171608.pdf
Find out how we monitor the use of the Mental Health Act
· http://www.cqc.org.uk/usingcareservices/mentalhealthact.cfm
Read the press release
· http://www.cqc.org.uk/newsandevents/pressreleases.cfm?cit_id=36395&FAArea1=customWidgets.content_view_1&usecache=false
Download the follow-up report:
· http://www.cqc.org.uk/publications.cfm?fde_id=15896
Nine recommendations were implemented on WLMHT in July 2009 after a year-long investigation of the Trust. The original report highlighted delays in investigating incidents and a failure to learn from common themes documented in action plans.
This was followed up by an inspection completed in March of this year, involving interviews with people who used services, staff and board members, and a review of documented evidence.
This inspection found that the trust had made improvements in:
· the assessment of physical health care
· the reporting, investigating and communication of risks
· the provision of primary care services
· cleanliness of wards
However, the trust must continue to make progress in:
· care planning
· improving communication between staff and people who use services
· demonstrating that lessons learnt are shared across the whole trust
CQC will continue to monitor the trust to ensure that recommendations are met. It will carry out a review of commissioning services later this year.
Find out more:
Read the original report
· http://www.cqc.org.uk/_db/_documents/Investigation_into_West_London_Mental_Health_NHS_Trust_FINAL_200907171608.pdf
Find out how we monitor the use of the Mental Health Act
· http://www.cqc.org.uk/usingcareservices/mentalhealthact.cfm
Read the press release
· http://www.cqc.org.uk/newsandevents/pressreleases.cfm?cit_id=36395&FAArea1=customWidgets.content_view_1&usecache=false
Wednesday 30 June 2010
Progress made in youth alcohol misuse, report shows
We have today published a report into the work of youth offending teams (YOTs) in tackling alcohol misuse by children and young people.
The joint report, completed with HM Inspectorate of Probation, Healthcare Inspectorate Wales and Estyn, shows progress has been achieved but more improvement must be made.
It confirms that YOTs are sufficiently aware of the link between alcohol misuse and:
· Health problems.
· Underachievement in school.
· Offending behaviour.
They are also offering significant and effective health resources where such misuse is believed to be directly linked to offending.
There were, the report found, too many inconsistencies in the quality of assessments across England and Wales, meaning some children will not get the appropriate help.
To address the problems, the report’s authors call for a nationally validated holistic health assessment to ensure appropriate interventions are offered.
Professionals should also ensure alcohol-related needs are prioritised more, the report says, in order to generate more consistent assessments and aligned interventions.
· Read the full press release on the publication:
http://www.cqc.org.uk/newsandevents/newsstories.cfm?FaArea1=customwidgets.content_view_1&cit_id=36371
· Download the full report from here: http://www.justice.gov.uk/inspectorates/hmi-probation/index.htm
The joint report, completed with HM Inspectorate of Probation, Healthcare Inspectorate Wales and Estyn, shows progress has been achieved but more improvement must be made.
It confirms that YOTs are sufficiently aware of the link between alcohol misuse and:
· Health problems.
· Underachievement in school.
· Offending behaviour.
They are also offering significant and effective health resources where such misuse is believed to be directly linked to offending.
There were, the report found, too many inconsistencies in the quality of assessments across England and Wales, meaning some children will not get the appropriate help.
To address the problems, the report’s authors call for a nationally validated holistic health assessment to ensure appropriate interventions are offered.
Professionals should also ensure alcohol-related needs are prioritised more, the report says, in order to generate more consistent assessments and aligned interventions.
· Read the full press release on the publication:
http://www.cqc.org.uk/newsandevents/newsstories.cfm?FaArea1=customwidgets.content_view_1&cit_id=36371
· Download the full report from here: http://www.justice.gov.uk/inspectorates/hmi-probation/index.htm
Tuesday 29 June 2010
Improvements at Basildon and Thurrock NHS Trust
· Download the progress report: http://www.cqc.org.uk/publications.cfm?fde_id=15861
In relation to two conditions, the trust has made the necessary improvements within the deadlines set, and we have now removed these two conditions. The conditions outline where and when the trust needs to improve to meet essential standards of quality and safety to be registered under the new monitoring system.
The trust has taken action to meet the following conditions:
·Carry out an assessment of need, including a risk assessment and a care plan for all patients
·Complete an action plan that responds to the trust’s maternity services
The removal of the two conditions comes after a joint site visit with the Health and Safety Executive (HSE). The visit involved observation of care and interviews with people who use services and hospital staff. The trust must meet the remaining three conditions by July and August 2010:
·provide training in the care of acutely ill patients
·set out systems of supervision and appraisal of staff
·keep the premises safe from legionella infection
There are additional improvements that still need to be made. Inspectors have concerns about:
·the observation of patients in the waiting area in A&E;
·poor provision of training to deal with work-related violence and aggression.
CQC will continue to make more unannounced visits and take further action to make sure the trust meets these conditions and addresses our concerns.
Find out more
·Read the press release: http://www.cqc.org.uk/newsandevents/pressreleases.cfm?cit_id=36365&FAArea1=customWidgets.content_view_1&usecache=false
·Find out how we monitor essential standards of quality and safety http://www.cqc.org.uk/aboutcqc/whatwedo/monitoringessentialstandardsofqualityandsafety.cfm
In relation to two conditions, the trust has made the necessary improvements within the deadlines set, and we have now removed these two conditions. The conditions outline where and when the trust needs to improve to meet essential standards of quality and safety to be registered under the new monitoring system.
The trust has taken action to meet the following conditions:
·Carry out an assessment of need, including a risk assessment and a care plan for all patients
·Complete an action plan that responds to the trust’s maternity services
The removal of the two conditions comes after a joint site visit with the Health and Safety Executive (HSE). The visit involved observation of care and interviews with people who use services and hospital staff. The trust must meet the remaining three conditions by July and August 2010:
·provide training in the care of acutely ill patients
·set out systems of supervision and appraisal of staff
·keep the premises safe from legionella infection
There are additional improvements that still need to be made. Inspectors have concerns about:
·the observation of patients in the waiting area in A&E;
·poor provision of training to deal with work-related violence and aggression.
CQC will continue to make more unannounced visits and take further action to make sure the trust meets these conditions and addresses our concerns.
Find out more
·Read the press release: http://www.cqc.org.uk/newsandevents/pressreleases.cfm?cit_id=36365&FAArea1=customWidgets.content_view_1&usecache=false
·Find out how we monitor essential standards of quality and safety http://www.cqc.org.uk/aboutcqc/whatwedo/monitoringessentialstandardsofqualityandsafety.cfm
Improvements at Tameside NHS Foundation Trust
We have lifted registration conditions previously imposed on Tameside NHS Foundation Trust.
We imposed the conditions on 1 April, when a tough new registration system for NHS trusts was introduced.
We required the trust to take urgent action to ensure:
- a sufficient number of qualified and experienced staff
- systems in place to manage and co-ordinate staff
To check the necessary improvements have been made, our inspectors made an unannounced visit to Tameside General Hospital on 16 June and interviewed patients, visitors and staff.
We found that the quality and safety of care, treatment and support for patients has improved since the March inspection.
However, we also identified some areas for further improvement and the trust is already taking action to ensure this work is completed. CQC will closely monitor these areas and check that this has resulted in improvements for patients.
Find out more
Read our press release: CQC lifts registration conditions on Tameside NHS
Foundation Trust:
http://www.cqc.org.uk/newsandevents/pressreleases.cfm?cit_id=36368&FAArea1=customWidgets.content_view_1&usecache=false
Download the full compliance report
http://www.cqc.org.uk/publications.cfm?fde_id=15862
We imposed the conditions on 1 April, when a tough new registration system for NHS trusts was introduced.
We required the trust to take urgent action to ensure:
- a sufficient number of qualified and experienced staff
- systems in place to manage and co-ordinate staff
To check the necessary improvements have been made, our inspectors made an unannounced visit to Tameside General Hospital on 16 June and interviewed patients, visitors and staff.
We found that the quality and safety of care, treatment and support for patients has improved since the March inspection.
However, we also identified some areas for further improvement and the trust is already taking action to ensure this work is completed. CQC will closely monitor these areas and check that this has resulted in improvements for patients.
Find out more
Read our press release: CQC lifts registration conditions on Tameside NHS
Foundation Trust:
http://www.cqc.org.uk/newsandevents/pressreleases.cfm?cit_id=36368&FAArea1=customWidgets.content_view_1&usecache=false
Download the full compliance report
http://www.cqc.org.uk/publications.cfm?fde_id=15862
Wednesday 16 June 2010
Regulator calls on Devon Partnership NHS Trust to ensure mental health services for older people are up to standard
The Care Quality Commission today (Wednesday) committed to use its new regulatory powers to ensure that older people in Devon are able to receive modern and effective mental healthcare.
In publishing the findings of a detailed investigation into older people’s mental health services, CQC says Devon Partnership NHS Trust has already made significant improvements to its services for older people.
But it says that a history of inadequate supervision of staff had allowed poor practice to continue unchallenged until 2008. The report highlights a failure to properly manage medicines, leading to medication being administered inappropriately in one unit, the Harbourne Unit in Totnes, until November 2008. The unit was closed last year.
The Care Quality Commission says it is satisfied that effective arrangements are now in place in Devon to protect the safety of patients, and that the trust is continuing to work on improvements.
The concerns about standards of care were first raised in November 2008, when a member of
staff reported poor practice on the Harbourne Unit, a ward for up to 10 people with mental health needs such as dementia.
The trust instructed its medical director to review care on the unit, looking specifically at the care of six people who died between October 2007 and November 2008.
The review did not find that poor care caused any of the deaths. However, it did find serious concerns relating to the inappropriate use of opioids, with drugs routinely used to control people’s behaviour, rather than treat their illnesses. It also found a failure of medical and nursing care, poor record-keeping and lack of care planning.
The trust informed the regulator (then the Healthcare Commission), which conducted inspections of the unit in December 2008.
The trust acted immediately to ensure the safety of patients by restricting the use of some medications and introducing closer supervision of clinical staff on the Harbourne Unit. The unit was permanently closed in July 2009.
In May 2009, at the request of the trust, the Care Quality Commission began a detailed investigation, reviewing care at all older people’s mental health units across Devon.
CQC conducted announced and unannounced inspections at nine units; investigating pharmacy arrangements and interviewing 172 current and former trust staff, as well as patients, relatives and carers. CQC also commissioned a review of case notes by external consultants.
The report concludes that the level of problems which were found on the Harbourne Unit did not exist in other units. However, it did find that units providing older people’s mental healthcare were isolated, with insufficient supervision of staff. As a result, the trust was not in a position to prevent things going wrong until a member of staff reported their concerns.
The report says that there were insufficient clinical governance arrangements to monitor safety and reduce risks in older people’s mental health services in Devon.
The Commission says the trust lacked a clear vision of the services being offered in its older people’s mental health units, with variations in standards of assessment, care and treatment. In particular there were no trust policies to manage challenging behaviour in patients with dementia or consistent systems to provide palliative and end of life care.
Amanda Sherlock, CQC’s deputy director of Operations, said: “The trust acted openly when allegations of poor care came to its attention and took prompt action to ensure the safety of its patients.
“After a thorough investigation, we found no evidence to suggest that the poor clinical practice found on the Harbourne Unit existed on the trust’s other wards.
“But it is clear that the trust should have been able to spot and address those problems earlier. Our report found that until these problems came to light, the trust appeared to have no oversight, leaving highly dedicated staff to cope without clear policies or guidance from the centre. The trust did not know whether standards of care were adequate or not.
“At an early stage of this inquiry we shared our findings with the trust, to give them the earliest opportunity to begin to make improvements. To their credit, Devon Partnership have moved swiftly to improve mental health services for older people without waiting for the publication of our report before beginning a programme of redesign and improvement.
“We will now continue to monitor that improvement through our new registration process, returning to the trust at regular intervals to ensure that this pace of improvement continues. We will use our powers to the full, if necessary, to ensure that older people in Devon receive modern and effective mental healthcare.”
Care Quality Commission inspectors have already begun work on a follow up review to establish if the trust is meeting new essential standards which came into force this year.
Under the new system of regulation, CQC registered the trust to provide services from 1 April on the condition that it took immediate action to improve its systems for the supervision and appraisal of staff.
CQC staff will now follow up that requirement and specific concerns highlighted by the report to identify whether further action needs to be taken to ensure that the trust complies with the new standards.
In publishing the findings of a detailed investigation into older people’s mental health services, CQC says Devon Partnership NHS Trust has already made significant improvements to its services for older people.
But it says that a history of inadequate supervision of staff had allowed poor practice to continue unchallenged until 2008. The report highlights a failure to properly manage medicines, leading to medication being administered inappropriately in one unit, the Harbourne Unit in Totnes, until November 2008. The unit was closed last year.
The Care Quality Commission says it is satisfied that effective arrangements are now in place in Devon to protect the safety of patients, and that the trust is continuing to work on improvements.
The concerns about standards of care were first raised in November 2008, when a member of
staff reported poor practice on the Harbourne Unit, a ward for up to 10 people with mental health needs such as dementia.
The trust instructed its medical director to review care on the unit, looking specifically at the care of six people who died between October 2007 and November 2008.
The review did not find that poor care caused any of the deaths. However, it did find serious concerns relating to the inappropriate use of opioids, with drugs routinely used to control people’s behaviour, rather than treat their illnesses. It also found a failure of medical and nursing care, poor record-keeping and lack of care planning.
The trust informed the regulator (then the Healthcare Commission), which conducted inspections of the unit in December 2008.
The trust acted immediately to ensure the safety of patients by restricting the use of some medications and introducing closer supervision of clinical staff on the Harbourne Unit. The unit was permanently closed in July 2009.
In May 2009, at the request of the trust, the Care Quality Commission began a detailed investigation, reviewing care at all older people’s mental health units across Devon.
CQC conducted announced and unannounced inspections at nine units; investigating pharmacy arrangements and interviewing 172 current and former trust staff, as well as patients, relatives and carers. CQC also commissioned a review of case notes by external consultants.
The report concludes that the level of problems which were found on the Harbourne Unit did not exist in other units. However, it did find that units providing older people’s mental healthcare were isolated, with insufficient supervision of staff. As a result, the trust was not in a position to prevent things going wrong until a member of staff reported their concerns.
The report says that there were insufficient clinical governance arrangements to monitor safety and reduce risks in older people’s mental health services in Devon.
The Commission says the trust lacked a clear vision of the services being offered in its older people’s mental health units, with variations in standards of assessment, care and treatment. In particular there were no trust policies to manage challenging behaviour in patients with dementia or consistent systems to provide palliative and end of life care.
Amanda Sherlock, CQC’s deputy director of Operations, said: “The trust acted openly when allegations of poor care came to its attention and took prompt action to ensure the safety of its patients.
“After a thorough investigation, we found no evidence to suggest that the poor clinical practice found on the Harbourne Unit existed on the trust’s other wards.
“But it is clear that the trust should have been able to spot and address those problems earlier. Our report found that until these problems came to light, the trust appeared to have no oversight, leaving highly dedicated staff to cope without clear policies or guidance from the centre. The trust did not know whether standards of care were adequate or not.
“At an early stage of this inquiry we shared our findings with the trust, to give them the earliest opportunity to begin to make improvements. To their credit, Devon Partnership have moved swiftly to improve mental health services for older people without waiting for the publication of our report before beginning a programme of redesign and improvement.
“We will now continue to monitor that improvement through our new registration process, returning to the trust at regular intervals to ensure that this pace of improvement continues. We will use our powers to the full, if necessary, to ensure that older people in Devon receive modern and effective mental healthcare.”
Care Quality Commission inspectors have already begun work on a follow up review to establish if the trust is meeting new essential standards which came into force this year.
Under the new system of regulation, CQC registered the trust to provide services from 1 April on the condition that it took immediate action to improve its systems for the supervision and appraisal of staff.
CQC staff will now follow up that requirement and specific concerns highlighted by the report to identify whether further action needs to be taken to ensure that the trust complies with the new standards.
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