CQC and HMIP call for improvements in healthcare for adults in the prison system

The Care Quality Commission (CQC) and Her Majesty’s Inspectorate of Prisons (HMIP) are calling for improvements in NHS healthcare provided for adults in the prison system in a joint report published today.

The findings of the 2008/09 report are based on a sample of 21 PCTs that commission healthcare for prisons. It indicates progress has been made in embedding management and clinical governance systems and also in the way IT systems are used to record and analyse information on the quality of care.

But CQC and HMIP say clear improvements must be made in broader arrangements to monitor the quality of care and to ensure care is centred on patients’ needs. The review flags up particular concerns over arrangements for continuity of healthcare around prisoners’ transfer and release. The report describes it as inadequate and says it appears to be getting worse.
There has also been no improvement in the provision of drug treatment systems, a potentially critical resource within a prison environment.

CQC programme manager, Alex Baylis, said: ‘We are encouraged to see some improvement in the standards of healthcare provided to adults in the prison system over the last year, but significant improvements still must be made.

‘CQC particularly wants to see improvements around arrangements for adults’ transfer and release, which appears to be getting worse. People in prison are often not registered with a doctor and have a high prevalence of chaotic lifestyles, which can involve – for example – substance misuse and mental health issues. Expecting them to make their own arrangements can mean they may end up without access to healthcare.’

Alex Baylis explained that healthcare in prisons was now covered by CQC’s new system of registration: ‘It is now a legal requirement for the NHS to meet essential standards of quality and safety and the independent sector will be subject to the same law from October.

‘This means we will be monitoring these services on an ongoing basis to ensure both are compliant with the regulations set out in the new system of registration.

‘If providers breach standards they will be committing an offence. If this happens, we will use our wide range of enforcement powers to prompt action. These escalate from warning notices to fines to cancellation of registration and the closure of services.’

The review assesses care provided and commissioned by a sample of primary care trusts (PCTs) over 2008/09 and compares them to the 2007/08 results.

Recommendations include:

- PCTs must develop the information they collect on the quality of service provision and on health promotion so they can better detect and correct unsatisfactory practice and better demonstrate that individual services they commission achieve their objectives for quality of care.
- PCTs must be able to show information systems are used for regular review of clinical standards and that these reviews are followed up with action where needed.

- PCTs must prioritise continuity of care at transfer and release and show that services for each prison in their area join-up effectively with other services.

- PCTs should be able to show they act on complaints in how they commission and monitor services.

This year providers of healthcare in prisons are subject to a new tougher system of statutory registration and must apply to CQC for a licence to provide services, declaring they meet legal essential standards. This system of registration gives CQC new powers to carry out enforcement action against providers if the quality of services falls below required levels. Providers of healthcare in prisons are subject to fines or legal proceedings if they fail to meet the required standards.

Although the registration system applies to providers and not to the commissioners of services, commissioners should play a major role in helping services improve and ensure they are giving top priority to monitoring quality of care, according to the report.

What to expect if your rights are restricted under the Mental Health Act

We monitor the use of the Mental Health Act and protect the interests of people whose rights are restricted under that Act.

Most people receiving mental health care do not have their rights restricted. However, in some instances this happens to protect the person receiving treatment and others.

We have published new information about:

- what to expect if your rights are restricted;
- what to do if you’re not satisfied with the care you have received.

Find out more: http://www.cqc.org.uk/newsandevents/newsstories.cfm?FaArea1=customwidgets.content_view_1&cit_id=36282

CQC lifts conditions on registration for Kent and Medway NHS and Social Care Partnership Trust

The Care Quality Commission (CQC) has today (27 May 2010) announced that it has removed two conditions placed on the registration of Kent and Medway NHS and Social Care Partnership Trust. The conditions both related to safeguarding vulnerable people who use services and the trust has provided evidence to show that they are now compliant. Since 1 April this year, all 378 NHS trusts who provide services in England are required to be registered with CQC, under a new system of regulation. To be registered, trusts had to show they met new essential standards of quality and safety, which CQC will constantly monitor.

Kent and Medway was one of the 22 trusts whose registration was conditional on action being taken to address concerns about the safety and quality of care. CQC set out the action required at each trust with strict deadlines for improvements.

In its assessment of Kent and Medway, CQC had been concerned with the trust’s implementation of the Mental Capacity Act. The trust’s informal leave policy promoted the detention of informal patients without any legal framework for the first three days of their in-patient care.

In order to be registered, the trust was instructed to revise its informal leave policy for non-detained patients in line with the Mental Capacity Act and deprivation of liberty safeguards. It was also
required to ensure that staff were trained to work in accordance with the reviewed policy.

Roxy Boyce, CQC's regional director, said: “The first condition related to the policy that sets out the rights of voluntary mental health patients at the Trust. This was removed on appeal after CQC received written evidence from the trust that addressed our concerns. We removed the second condition relating to staff training around this policy following a meeting with trust senior management on 14 April and three site visits by inspectors on 19 April. “During the site visits we spoke to people using the trust’s services and to staff. The visits provided clear evidence that a high percentage of staff have been trained since the end of March and that this has had a positive impact on the experience of patients. ”We are satisfied with the progress that the trust has made to safeguard the rights of people who use services, based on our recommendations. As part of the CQC's new regulation system, we will continually monitor the trust to ensure it is providing safe, quality care to the people it serves.”

Big improvements in hospital cleanliness and mixed-sex accommodation, finds major NHS survey

But Care Quality Commission urges NHS to tackle lack of information about medicines
A major survey of 69,000 NHS hospital inpatients points to big improvements in cleanliness and a decline in mixed-sex accommodation, says the Care Quality Commission.

The Commission today published the results of the 2009 NHS Inpatient Survey coordinated by Picker on behalf of CQC, covering 162 hospital trusts in England.

CQC said many of the survey questions relate to essential standards of quality and safety that trusts must meet under the new registration system that came into operation on 1 April. The information is used to monitor performance in the NHS.

In 2009, 64% of patients rated their hospital room as “very clean”, up from 60% in 2008 and 56% in 2002. The Commission said this mirrored year-on-year improvements in all questions related to infection control, such as whether bathrooms were clean and if staff washed their hands.

In 2009, the proportion of patients who reported sharing accommodation with the opposite sex fell significantly. For emergency patients, 21% said they initially stayed in mixed-sex accommodation, down from 29% in 2008. The proportion of people admitted from waiting lists to mixed-sex accommodation also decreased, from 10% in 2008 to 8% in 2009.

But the Commission said progress was disappointing in some important aspects of care and in some cases the experience of patients had got worse.

The survey showed significant room for improvement around the information given to people about medicines. The proportion of patients who said they were not given enough information about the purpose of medicine they were given to take home has steadily increased, from 7% in 2002 to 8% in 2008 and 9% in 2009. In 2009, 45% of patients said they had not been given enough information about potential side effects of medication, up from 44% in 2008 and 2002.

The Commission said the NHS must address the lack of help for patients to eat. Almost one in five patients (18%) said they did not get enough help to eat their meals if they needed it – the same as in 2002. There was an increase in the proportion who said they “always” received enough help to eat, but a corresponding decrease in the proportion who said they “sometimes” received enough help.

Overall, 44% of people rated their care as “excellent”, 35% “very good”, 13% “good”, 5% “fair” and 2% “poor”. This shows improvement since 2002, when the figures were 38%, 36%, 17%, 7% and 2% respectively.

Cynthia Bower, CQC’s chief executive, said: “The survey results have shown year-on-year improvements in many important aspects of hospital care. Infection control and mixed-sex accommodation have been a big concern for patients, so it’s encouraging to see the substantial improvements in these areas.

“But there are also some persistent problems that the NHS is struggling to address. It is unacceptable that almost 50% of patients did not have the potential effects of medicine properly explained to them. I’m also concerned that some people who need help to eat are not getting enough assistance. These are fundamentals of care and it is time for the NHS to tackle these issues head-on.”

NHS trusts use the survey results to identify where improvements are needed and to track the experience of patients in hospital.

The Commission uses the survey results to monitor performance in the NHS. CQC analyses the survey results alongside a range of other information, such as findings from inspections, data on mortality and infection rates and intelligence from other organisations, to monitor compliance with the new essential standards of quality and safety and to help determine where further regulatory action is needed.

Ms Bower said: "We are using more and more information from patients to help identify where we need to focus our efforts as the regulator. Many of these questions relate to the registration standards and we will be using this information from patients when we assess and inspect trusts.

“We expect every NHS hospital trust to pay close attention to their results and plan how they can improve the experience of hospital patients.”

Important changes to CQC’s assessment of adult social care services

CQC is working closely with the adult social care sector in developing a new system to replace quality ratings (star ratings) for registered social care services.

The current quality ratings system will cease ahead of the new registration system and new standards, which come into force on 1 October under the Health and Social Care Act 2008.

CQC has already begun talks with stakeholders to discuss how a new system might work. It will also draw on feedback from the recent consultation on assessments of quality in 2010-11 and will launch a further programme of work later this year to develop different options.

Key inspections due to take place between now and September would be brought forward. By the end of June, CQC will have completed key inspections at all “poor” services and at all “good” and “excellent” services that have not been inspected for three years. Current ratings can be changed as a result of these inspections.

Until 1 October, CQC will continue to conduct risk-based inspections when it receives information indicating concerns about safety and will continue to publish the inspection reports on its website. These may be key inspections, which could result in change to a rating, or a random inspection, which will not involve a rating.

CQC will also inspect services if it needs further information to assess applications to re-register under the new registration system.

From 1 October, inspections will be conducted under the new model of regulation to assess compliance with the new essential standards of quality and safety. Findings from inspections will be published on the social care services directory.

Care Quality Commission brings in extra advice on adult social care

The Care Quality Commission announced today that it has brought in two advisors to add to its experience and expertise in adult social care and to help develop its relationship with the sector.

Bill Hodson has been appointed as national advisor on adult social care, working at both policy and operational levels. He will provide advice on best practice, contribute to policy decisions and strengthen partnerships with stakeholders and other organisations. He joins a small team of national advisors who have current or recent practice experience at a senior level in health and social care. His appointment is initially for a year and he will spend one day a week on his CQC work.

Mr Hodson has more than 30 years' experience of social care, housing and corporate governance in local authority roles. Until recently he was director of housing and adult social services for the City of York Council, and a member of the national executive of the Association of Directors of Adult Social Services (ADASS).

Barbara Laing is helping the commission in the run-up to the registration of adult social care providers under the Health and Social Care Act 2008. Over the next six months, working two days a week for CQC, she will offer an additional channel of communication with providers while assessing what is working well in the registration process and advising the commission on what could be done better.

Ms Laing worked for 14 years for Anchor, England's largest not-for-profit provider of housing and care to older people, where latterly she was responsible for its 30,000 rented and leasehold properties. Previously she ran the organisation's portfolio of 100 residential and nursing homes.

Before that she spent 20 years in social care with Birmingham City Council.

CQC chief executive Cynthia Bower said: "I'm very pleased that both Bill and Barbara are able to get involved with our work. I'm confident that their experience in senior roles within the adult social care sector will enable them to make substantial contributions to our relationships with providers and commissioning bodies.

"The arrangement with Barbara mirrors the one we had with Sir Neil McKay, chief executive at the East of England Strategic Health Authority, whom we brought in to lend his expertise in the period leading up to the registration of NHS trusts from 1 April. His feedback was very constructive and we used it to improve our engagement and information sharing with trusts and the wider public."

Bill Hodson's starting point in his new role is to talk to a range of stakeholders and take stock of what they would like to see from CQC. He sees good regulation as an essential part of the improvement agenda.

He said: "The commission genuinely doesn't want to just use its regulatory powers as a big stick to beat commissioners and providers with, but to work with them on improving services. It wants to get the balance right, and I'm sure this positive approach will be welcomed by the sector."

Mr Hodson says the regulator's role is central to the development of partnerships between social care and health services.

"I think CQC is aware that it has a unique position in terms of promoting more integrated forms of delivery, and is looking at how best to take advantage of this.
"As personalisation increases, more people will be living independently and we'll all need to make sure that the transition is managed across both health and social care."

Barbara Laing says CQC has asked her to look objectively at how well the process of registering adult social care providers is progressing, and to flag up problems and suggest solutions. She feels it will help that she has experience of both the commercial environment and the public sector.

Ms Laing will have discussions with the trade associations and will also be looking for other ways to engage with providers, especially the smaller ones and those that are coming into registration for the first time, such as some drug treatment residential centres and supported living services.

"Smaller providers obviously don't have the infrastructure of the big corporates and it's quite a challenge for them to think about how they can work within the new registration standards to achieve improvements," she said. "I want to find out how CQC can help them to do this."