Using the Emergency Support Framework (ESF) in NHS acute, mental health and combined trusts
Ted Baker, Chief Inspector of Hospitals, updates on our use of the Emergency Support Framework (ESF) in NHS acute, mental health and combined trusts.
COVID-19 has put an unprecedented amount of pressure on health and social care, but we have seen an overwhelming amount of innovative and adaptable processes and practices in response to this. We have all had to change the way we work and be flexible and adaptable as the situation changes rapidly.
At CQC this meant pausing routine inspections to stop our inspectors inadvertently spreading the virus and to reduce demand for scarce personal protective equipment (PPE), During this period we introduced the Emergency Support Framework (ESF), a framework for CQC inspectors to have structured and consistent conversations with providers, while also being assured that the people in their care are being kept safe. Providers also have the opportunity to discuss their approach and highlight any particularly good or innovative practice, and it provides a forum for constructive challenge, support and advice.
So far, the ESF has been successfully used in adult social care, primary medical services and some independent services, including services for people with a learning disability and/or autism, independent ambulance providers and independent dialysis units.
‘The next steps for CQC does include a return to inspection, but we won’t just be returning to business as usual’
When we introduced the ESF we wanted to be clear that we would look to improve and adapt the process depending on the changing needs of each care sector, which leads me to how we will use the ESF in NHS acute, mental health and combined trusts.
We know that effective infection prevention and control (IPC) is vital to keeping people using services safe during the pandemic and will be equally as important when trusts begin looking at how to safely and effectively reinstate non-COVID services. In April NHS England and Improvement published guidance on IPC, including a board assurance framework, to help trusts with this planning.
To assure us that trusts have these procedures in place we began having ESF conversations from 22 June with providers of NHS acute, mental health and combined services specifically about IPC. We want to discuss plans for IPC during the pandemic and beyond and be assured that plans are in place to keep people using services safe through effective IPC. The information we gather through these conversations will be used to monitor risk, identify where providers might need extra support and ensure they are delivering safe care which protects people’s human rights.
‘We want to help providers improve care and we will work with them to understand how we can support this’
The next steps for CQC does include a return to inspection, but we won’t just be returning to business as usual. We are going to widen our scope for inspections from services where we had immediate concerns about people’s safety, to those services where we have evidence that care needs to be improved. We will be moving forward in the same flexible way that we have done throughout the pandemic, as we need to ensure we do not stifle the innovation that is taking place. This could mean more short, targeted inspections with reports which are more succinct and produced more quickly while still providing an in-depth analysis of the care people are receiving.
We will also find a way of re-visiting providers where we were unable to complete well-led inspections due to the pandemic. In some cases, coronavirus has created a gap between core service and well-led inspections, meaning some providers have seen their service-level reports published before we were able to complete a well-led inspection and publish the full inspection report and any associated ratings information. We are working with providers on how to do this in the safest way, and we will update on this as soon as we can.
We want to help providers improve care and we will work with them to understand how we can support this, as well as keep talking to people who use services. Inspections are always going to be crucial to the way we regulate, but we will also continue to develop our monitoring tools — building on the ESF — and learn from how we have responded to COVID-19 to make sure we support providers to provide the best possible care.