Chief Inspector of Adult Social Care, Kate Terroni, sets out our next steps to support adult social care during the COVID-19 pandemic

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Chief Inspector of Adult Social Care, Kate Terroni

Following many conversations with adult social care providers, people who use services, their families and carers, Government, local government, and colleagues here at CQC I know how challenging things are for people with care and support needs and providers and how heroically people are responding, on both personal and professional fronts.

Over Easter I worked alongside many colleagues to contribute to COVID-19: our action plan for adult social care, published by the Department of Health and Social Care today. The role the CQC plays in delivery of this action plan has been shaped by what I’ve heard from the many conversations I’ve had, and so I want to share more on that with you here.

The action plan has four pillars:

  1. Reducing the spread of infection in care homes
  2. Supporting the workforce both to provide high quality care, and to cope with the practical and emotional demands of caring during the pandemic
  3. Supporting independence, end of life care and responding to individual needs
  4. Supporting the organisations that provide care.

At CQC we have developed our framework of support for health and social care providers alongside our regulatory role, and how we can use the skills and information we hold to drive action at national, regional and local levels. This new Emergency Support Framework will help deliver across all four pillars of COVID-19: our action plan for adult social care. We’ll be sharing more about this work soon.

We know from what providers of care have told us, that COVID-19 is having a devastating impact both on the people they care for, and on adult social care staff. We have been sharing what we hear — especially concerns about PPE and testing for staff — with local and national system partners so that we can work together to find solutions and target additional resource and support where it’s needed. The action plan addresses many of these concerns.

I’m really pleased that we’ve been able to use CQC’s national infrastructure to deliver a new service that enables care staff who are self-isolating due to symptoms of coronavirus to book an appointment at one of 12 testing sites across the UK, and where they will soon be able to order a kit for a test at home. We’ll be working with colleagues in local government as this new service rolls out to all providers. This means care staff can have more peace of mind about the safety of themselves, their families and the people they care for, and that those who test negative can return to work sooner, which will help relieve pressures services are facing.

This week we’ve also launched a regular data collection on COVID-19 related pressures (such as shortages of PPE) from services who provide care for people in their own homes, with the ability to refer staff for testing built in. This information will be combined with information already gathered from residential and nursing homes (via NHS Capacity Tracker) giving us a much more complete picture of how coronavirus is affecting adult social care. This information will be shared across organisations who can help mobilise support, such as the Department of Health and Social Care, Regional Command Centres, and Local Resilience Forums, Local Authorities and Clinical Commissioning Groups, as well as CQC’s inspection teams.

As we’re all only too aware, there are daily updates on the number of people who have died in hospital after testing positive for coronavirus. But it has been more difficult to track the number of deaths that occur outside hospital in the same way. Death notifications submitted to CQC by adult social care providers show a significant increase in deaths since late March. However, the limited availability of testing outside hospital means the number of deaths of people in care settings with confirmed COVID-19 remains very low, as reflected in current ONS data, which are based on death certificates. Because of this we’ve made a change to our system of notifications, which will allow a provider to report whether a death was of a person with suspected or confirmed COVID-19. As well as giving more transparency on the impact of COVID-19 on the care sector, this will provide a regional view which allows an assessment of which areas are most impacted and may need additional support as a result.

Supportive conversations between CQC inspectors and providers are an important part of our Emergency Support Framework, as is easing the burden on providers during this time. I know from feedback shared with me that adult social care providers have appreciated my team being in touch with them to offer support. I want to say to all providers: my team are here to have a conversation with you to talk through any tough decisions you need to take and to offer advice where appropriate. Think of these as a conversation with a colleague, not as one you’d have with a regulator: while we all have distinct roles to play, we are all in this together and share the goal of keeping people safe. And to ease the burden on our we won’t be asking you to complete your provider information return or issuing any new ones.

Caring for people means supporting their independence and responding to individual needs, including at the end of life. Hearing from people in care and their loved ones about what they are experiencing has also never been more crucial and we urge people to get in touch with us directly through the Give Feedback on Care form on our website or by calling us on 03000 616161. Information we gather through this route, alongside what providers share with us, whistleblowing and other data, will help us to perform our regulatory role in unique circumstances. Our duty to act on that has not gone away. Where we identify a risk, we will be asking inspectors to get in touch with the provider to have a conversation, exploring areas likely to be most under pressure during this crisis.

The outcome of this conversation might be the identification of things the provider can do to resolve issues, but there might also be occasions were the information we have suggests we need to take a closer look.

As you’d expect, where we find abuse or intentional harm, we may undertake a targeted inspection — and in these cases we may also need to take enforcement action.

I know how pressured it feels right now. To ensure we all do the right thing and make the best decisions we can, we all need to share what we know, keep our conversations open and honest, ensure we capture our rationale for what we do and don’t do, and encourage feedback from people who use services.

Everyone in adult social care has a role in keeping people safe and you’ve all been doing an amazing job: I’ve never been more proud to be part of your team.

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