Report of the Deputy Leader and Cabinet Member for Health, Care and Wellbeing
Quality assurance of care homes had been undertaken by the Care Quality Commission (CQC) and Healthwatch. Over the last five years this had evolved to include the work of the in-house Quality Assurance Team (QAT). The QAT collated data from across the health and social care economy for care homes and monitored all registered provision in Staffordshire.
The County had a large and diverse market, with 252 care homes, and were the second largest local authority for nursing beds in relation to their comparators. A joint health and social care risk matrix was used for the adult social care market which the QAT managed and used to track and assign levels of risk of care providers. Risks were reviewed and monitored through the monthly multi-agency Quality and Safeguarding Information Sharing Meeting (QSISM), with the level of risk the determinant for subsequent actions. Local Authority Quality Assurance visits were targeted at risk services with an emphasis on quality assurance. Members were informed that there remained some pockets of inconsistency but pro-active work was being undertaken to improve consistency across the County.
Staffordshire had on average 10% (25 care homes) more services outside the expected quality standards compared to West Midlands and national averages for the whole market. However Staffordshire performed better than both the regional and national averages for community services. The number of good services had seen an increase over the past two years from 55% to 72%. Staffordshire had also seen an improving picture regarding provider failure, with a multi-agency standard operating procedure in place which outlined how agencies would respond.
Healthwatch were a partner of QSISM and carried out visits to care homes through their “Enter and View” powers. However their role was different to both that of the CCG and the County’s Quality Assurance Team, focusing on the customer experience.
The Select Committee received details of the actions taken to improve services and the introduction of the Quality Improvement Process (QIP), which was a multi-agency approach focusing on proactive intervention at an earlier stage.
The QAT was made up of seven quality assurance officers, an information analyst and a team manager. The Team worked closely with two lead nurses from the CCGs and a range of other part time nurses. When necessary Commissioners would also work with the Team on specific projects. Required actions, where care homes presented a risk, would be taken as appropriate depending on the risk rating. Where necessary action could be taken within a day, at other times within a month, depending on the nature and urgency of risk.
A multi-agency standard operating procedure was in place which outlined how agencies would respond. This evolved as lessons were learnt and included very detailed information to ensure residents were kept safe and retained their dignity whatever the outcome for the care home, drawing upon the wider capacity of the Council where necessary.
Details of quality assurance were made public to enable transparency for Staffordshire residents. The Select Committee applauded this transparency. They heard that there was a shortage of qualified nurses for nursing homes and that this was part of the STP work stream. The complexity of need of nursing home residents meant the care required was more challenging.
Members heard that, where care homes had financial difficulties, they were often able to rectify the situation through refocusing their business. However should the actions taken not improve the financial status of the company then measures could be taken to ensure the safeguarding of residents.
RESOLVED – That:
a) the working arrangements for quality assurance and the key activities undertaken be noted; and
b) the Quality Assurance Team be applauded for the systematic and thorough analysis and for the transparency of care quality information for Staffordshire residents.