CQC Raises Serious Concerns Over Care at Residential Detox Clinics

The Care Quality Commission (CQC) has published a briefing today (Thursday 30 November) based on inspections over the last two years of the 68 services in the independent sector that have been identified as providing residential detoxification. In it, the regulator has uncovered multiple concerns.

Many of the clinics were found to be not assessing the risks to the safety of the people within their care prior to their admission; were not following recognised national clinical guidance on how to treat people who are withdrawing from alcohol or drugs; were not storing, dispensing and handling medicines appropriately and were not carrying out full employment checks or sufficiently training their staff.

Nearly three in four (72%; 49) of the providers that CQC had inspected were found to have been failing in at least one of the fundamental standards of care that anyone should have a right receive.

The regulation on ‘safe care and treatment’ was where CQC found the most breaches: 43 providers (63%) were not meeting this particular standard at the time of their first inspection.

Examples of what CQC found on its inspections include:

• Staff administering medication, including controlled drugs like methadone, without the appropriate training or being assessed as competent to do so.
• Staff giving paracetamol to people within their care more frequently than every four hours despite them already having, or being at a greater risk of having, liver damage due to their heavy alcohol use.
• Staff not having planned how they would manage a person’s epileptic fits during their withdrawal (e.g. by prescribing anti-seizure medication) despite knowing from their medical history that they were at risk of having seizures.
• Staff lacking appropriate training in basic life support, consent and mental capacity and safeguarding.
• Some units carrying out Disclosure and Barring Service (DBS) checks for newly employed staff but not at routine intervals afterwards.

Four of the services are no longer operating following the concerns raised by CQC on its inspections.
 
Rosanna O’Connor, Director of Drugs, Alcohol and Tobacco at Public Health England, said:  "Our evidence review of drug treatment services earlier this year found they were largely performing well. But we welcome the light this report shines on the clinical practice in some residential detox services, which were falling short of keeping those in their care safe and providing the best springboard for recovery.

"While residential detox makes up a small part of the overall treatment system, seeing about 1% of all in treatment, they do have a vital role. It’s crucial these services are in line with best practice, as the Clinical Guidelines on drug treatment clearly sets out. This helps ensure not only safety but gives some of the most vulnerable and disadvantaged people the best chance of getting their recovery on track.

"PHE has already been working with these services to help them improve and we will continue to provide this support."

CQC Leaves Out of Hours Service in Special Measures

The Care Quality Commission (CQC) has told Nestor Primecare Services Ltd t/a Primecare – East Kent (Nestor) that it must make further improvements to its NHS 111 and GP Out of Hours services following a recent focused inspection of its services.

This inspection was to follow up progress against three Warning Notices which had been issued in May 2017, when the company was first placed into special measures. 

Nestor must make a number of improvements including:

• ensuring care and treatment is provided in a safe way to patients.
• introducing effective systems and processes are in place to help ensure good governance in accordance with the fundamental standards of care.
• ensuring sufficient numbers of suitably qualified, competent, skilled and experienced persons are deployed to meet the fundamental standards of care and treatment.

Ruth Rankine, Deputy Chief Inspector of General Practice, said “I am disappointed to see that the organisation is still demonstrating that they cannot provide the service that patients need and we have issued a further two warning notices to ensure care and treatment is being provided in a safe way for service users and will continue to monitor this."

“Services need to demonstrate that they are ensuring people with the most urgent needs are prioritised at times of high demand, and to ensure that care and advice is delivered safely and effectively, and they are referred to the right service as quickly as possible when necessary."

“We will continue to work closely with our stakeholders to monitor and inspect the service to ensure that improvements are put in place."

Student Finance Reform Only Benefits the Highest Earning Graduates

In October, alongside a significant change to the threshold at which student loans are repaid, the Prime Minister Theresa May announced an inquiry into the student loan system.

The IFS was asked by Universities UK (representing Universities) to explore options for reforming the student loan system and they have now published their findings in a briefing note entitled “Options for reducing the interest rate and reintroducing maintenance grants”.

In the briefing note two options for reform to aspects of the student loan system that have been widely discussed are reviewed. The first is the high interest rates assigned to student debt - currently RPI + 3% while studying and RPI + 0-3%, depending on income, after leaving university. The second is the fact that - following the abolition of maintenance grants in 2016 - those from the poorest backgrounds currently graduate with the largest debts.

Key findings:

• Reintroducing grants of £3,500 would increase deficit spending by around £1.7 billion, but the long-run cost is only around £350 million. This reform would reduce the debt on graduation of students from low-income backgrounds taking a three-year degree by around £11,000.
• Reducing the interest rate doesn’t impact on up front government spending, but it does increase the long run cost of the system. 
• Reducing interest rates only reduces the repayments of the highest earning graduates. This is because only high earning graduates end up repaying the interest on their loans. For most graduates this is written off at the end of the repayment period. The lowest earning 70% of graduates would be completely unaffected by changing the interest rate to RPI + 0% for all graduates. 
• Despite having no impact on upfront spending, reintroducing maintenance grants would increase the deficit. Grants count towards the deficit and loans do not, even if they are not expected to be repaid. Bringing back grants similar to those in place before 2016 grants would add around £1.7 billion to the deficit per year. 
• The long run cost of bringing back grants would be considerably lower, however. This is because a high proportion of the additional maintenance loans given to students from low-income backgrounds are not repaid anyway. The long-run cost of bringing back the pre-2016 style grants would be around £350 million a year. 
• Reintroducing maintenance grants only reduces the repayments of graduates who grew up in low-income households who go on to have high earnings. Only the highest-earning graduates end up paying of the additional maintenance loans under the current system. The majority of those eligible for the full maintenance grant would see no change to their lifetime repayments, while those who go on to high earnings could save around £22,000 over their lifetimes. 

Chris Belfield, an author of the report, said “Some of the features of the current student loan system are clearly deeply unpopular. Bringing back maintenance grants or reducing the positive real interest rate might help to address these concerns. However, these policies would increase the long-run cost to government and predominantly benefit high-earning graduates”

Commenting on the analysis, Alistair Jarvis, Chief Executive of Universities UK, said: "We agree with the IFS that there are ways the government could improve the current student funding system in England. While the current system has provided sustainable funding and promotes access, it needs to be better understood and needs to feel fairer to our students and their families. This analysis from the IFS provides a useful contribution to the ongoing debate.

"Students tell us that it is cash in their pockets while studying that matters most. We would like to see the government provide new investment to bring back maintenance grants aimed directly at those students who find it hardest to meet day-to-day living costs when they are studying. We also need to boost flexible learning through more government support for adults to retrain or improve their skills."

Government Green Paper on Care for Older People Delayed Until Summer 2018

Ministers have been accused of "dragging their feet" on a promised shake-up of social care funding after First Secretary of State Damian Green quietly released a statement deferring the publication of the much anticipated green paper until summer 2018.

The paper was originally planned for the end of 2017 but the Government has stated that it needs more time to find a long-term solution, as an ageing population and increased demand heap pressure on the wider health service.

The paper will set out plans for how the government proposes to improve care and support for older people and tackle the challenge of an ageing population.

First Secretary of State and Minister for the Cabinet Office, Damian Green, said “An ageing population needs a long-term solution for care, but building a sustainable support system will require some big decisions. In developing the green paper, it is right that we take the time needed to debate the many complex issues and listen to the perspectives of experts and care users, to build consensus around reforms which can succeed.”

The government has begun a process of engagement in advance of the green paper to ensure it reflects a wide range of views and requirements, working with:

• Caroline Abrahams – Charity Director of Age UK
• Dame Kate Barker – former Chair of the King’s Fund Commission on the Future of Health and Social Care in England
• Sir David Behan – Chief Executive of Care Quality Commission
• Dr Eileen Burns – President of the British Geriatrics Society
• Professor Paul Burstow – Chair of the Social Care Institute for Excellence
• Jules Constantinou – President-elect of the Institute and Faculty of Actuaries
• Sir Andrew Dilnot – former Chair of the Commission on the Funding of Care and Support
• Baroness Martha Lane Fox – Founder and Executive Chair of Doteveryone
• Mike Parish – Chief Executive of Care UK
• David Pearson – former President of the Association of Directors of Adult Social Services and Corporate Director for Social Care, Health and Public Protection at Nottinghamshire County Council
• Imelda Redmond – National Director of Healthwatch England
• Nigel Wilson – Chief Executive of Legal and General

Once the green paper is published in summer 2018, it will be subject to a full public consultation.

In response to the announcement Caroline Abrahams, Charity Director at Age UK said "It is crucial that this consultation process finally results in the improved, fair and sustainable care system that is so desperately needed. In the meantime, however, it is important that action is urgently taken to ease the all too obvious funding pressures that are undermining the services on offer to older people."

Educational Writers' Award Shortlist Announced!

The six books that have been shortlisted for the 2017 ALCS Educational Writers’ Award, this year focusing on the 5-11 age group have been announced!

Now in its tenth year, the Educational Writers’ Award was established in 2008 by the Authors’ Licensing & Collecting Society (ALCS) and the Society of Authors (SoA) “to celebrate educational writing that inspires creativity and encourages students to read widely and build up their understanding of a subject beyond the requirements of exam specifications”. The 2016 winner was This is Not a Maths Book: A Smart Art Activity Book, written by Anna Weltman, and illustrated by Edward Cheverton and Ivan Hissey.

The winner will receive a cheque for £2,000 and will be presented with their award at the All Party Writers Group (APWG) Winter Reception at the House of Commons on Tuesday 5th December.

This year’s shortlist includes:

SECRETS OF THE SEA by Kate Baker, illustrated by Eleanor Taylor (Big Picture Press / Templar)

This lavishly illustrated, large format book takes young readers on a journey of discovery from rock pools along the shoreline, to the deepest, darkest depths of the ocean to uncover an incredible, and rarely seen world.

"Taking its readers on a diving experience to discover the wonders of the deep blue sea, this book has a well-written and accessible text which will appeal to a wide range of ages, and beautiful artwork which brings the marine world to life."


FLUTTERING MINIBEAST ADVENTURES by Jess French, illustrated by Jonathan Woodward and paper engineering by Keith Finch (Red Shed / Egmont)

Find out how caterpillars change into beautiful butterflies, pond dip for baby dragonflies, and then continue the journey with the pop and play minibeast model which awaits the reader at the end of this colourful book. Each adventure is full of facts and activities that encourage children to explore the world around them.

"A bright, inviting and informative book, clearly written without being patronising. Its magical ideas are superbly laid out, with accessible text that will appeal to younger and early readers."


GENIUS! THE MOST ASTONISHING INVENTIONS OF ALL TIME by Deborah Kespert, designed by Karen Wilks (Thames & Hudson)

From Archimedes’ machine for carrying water uphill, to Tim Berners-Lee’s creation of the World-Wide Web, here are gripping stories of brilliant brave inventors who dared think the unthinkable and do the impossible, and so helped create our 21st century world.

"Full of interesting information enlivened with beautiful photographs, drawings and paintings, this is a fascinating book which ranges across technologies and across time, with a varied approach which will appeal equally to early, and more advanced readers."


HOW TO CODE IN 10 EASY LESSONS by Sean McManus, illustrated by Venitia Dean (QED Publishing / Quarto)

Teaching young readers how to design and code their very own computer games, this book gives readers the ten essential skills to get started.

"Providing a lively way into an exciting new subject for all age groups, this book approaches complex ideas with both humour, and beautiful clarity. Full of handy tips and easy-to-understand instructions, it succeeds in making coding a fun activity for both boys and girls."


TREE OF WONDER: The Many Marvelous Lives of a Rainforest Tree by Kate Messner, illustrated by Simona Mulazzani (Chronicle Books)

Deep in the forest, in the warm-wet green, who makes their homes in the almendro tree? Count each and every creature as life multiplies again and again in this vibrant and lush book about the rainforest.

"Based on the wonderful idea that a single tree supports thousands of lives, this is an attractive and layered picture book with two kinds of text; a simple text about one kind of animal associated with the tree, with more detailed information about that animal alongside. Its brilliant use of numeracy activities, and its gorgeous illustrations will encourage lots of questions."


THE BOOK OF BEES by Wojciech Grajkowski, illustrated by Piotr Soscha and translated by Agnes Monod-Gayraud (Thames & Hudson)

Who survived being stung by 2443 bees? What does a beekeeper actually do? How do bees communicate? This epic encyclopaedic book illustrated by popular Polish cartoonist, Piotr Socha (and son of a beekeeper!) tracks bumble bees from the age of the dinosaurs to their current plight, examining the role bees have played throughout history and in the rest of the natural world.

"A beautifully and wittily illustrated compendium of information all about bees and their interconnectedness with the world. Broad in its themes and containing lots of humour, it takes in the ancient Greeks and Egyptians, entymology, botany, the Bible, design, technology and much more."

Businesses Encouraged to Apply for Gigabit Broadband Grants

Businesses in four areas of the country are being encouraged by the government to apply for grants of up to £3000 to get gigabit broadband installed as part of a £2 million trial.

Suppliers will be offering vouchers worth between £500 and £3000 each to local businesses which can then be used to pay for the installation of gigabit speed connections. The aim of the pilots is to encourage the market to extend full fibre infrastructure in the UK by increasing demand and reducing the cost to customers.

Four areas of the UK have been selected to test the market conditions and infrastructure conditions. If successful the programme will be rolled out across the country.  The areas are:

• Aberdeen and Aberdeenshire
• Bristol, with Bath and North East Somerset
• Coventry and Warwickshire
• West Yorkshire Combined Authority (Bradford, Calderdale, Kirklees, Leeds, Wakefield and York)

The many benefits of a full fibre gigabit connection include:

• allowing businesses to upload and download massive files in a matter of seconds
• enabling widespread use of video conferencing throughout an organisation
• providing an unprecedented level of reliability whilst greatly enhancing resilience
• future proofing - making sure that businesses have the technology in place to deal with the ever-increasing demands for internet speed and connectivity
• allowing businesses in remote communities to compete on a technologically level playing field with those companies based in major cities who may already have full fibre connectivity

For more information on the scheme, visit https://gigabitvoucher.culture.gov.uk/

Innovative Learning, Development and Communication Strategy Key to GP Practice Outstanding Rating from CQC

Following an inspection in August 2017 The Care Quality Commission has found the quality of care provided by Chorley Surgery to be Outstanding.

Inspectors rated the practice as Outstanding for effectiveness and well-led and Good for safety, caring and responsiveness.

The practice was commended on:

• The surgery's bimonthly staff news bulletin, used as part of the practice’s learning, development and communication strategy. It provides comprehensive information for staff about the significant events, complaints and patients feedback received in the preceding two months and the changes implemented as a result of these.
• The partnership and management team's structure.  With distinct roles and responsibilities, utilising the experience and skills of each member to the full. As a result of this structure, all business and clinical matters were delivered effectively at the practice.
• Its clearly defined and embedded systems for the reporting and recording significant events. Significant events were investigated and learning outcomes are shared with the practice team to enhance the delivery of safe care to patients.
• Mechanisums for gathering feedback from patients, with an active patient participation group, which influenced practice development. 
• Its strong focus on continuous learning and improvement at all levels.

CQC’s Deputy Chief Inspector of General Practice in the North, Alison Holbourn, said "“This is an innovative and collaborative practice that has done some outstanding work in partnership with other GP practices. There is a strong commitment to patient centred care. The practice has initiated a range of quality improvement projects for both their own patient population and within a locality of 50000 patients. These included working with the local authority, paramedics, and the Lancashire Wellbeing Services to provide a Primary Care User Support team (PCUST) to identify patients who frequently need to use primary care services to provide them with a personalised care and support programme."

“Additionally, the practice provided clinical support and treatment to their own patients with Type 1 and Type 2 diabetes (including complex cases) and the patients of the five GP practices they worked collaboratively with. The initial impact of the service enabled patients to be seen quickly within a three to four week wait at the diabetic hub as opposed to the secondary care waiting list of 20 weeks or more."

“Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs. For example following a request from the practice the palliative care team now held regularly palliative care clinics at the practice. The practice demonstrated a wider community focus and provided services on site that could be accessed by patients who were registered at one of the five other practices."

A full report of the inspection has been published on the CQC's website.

5 Very Different Writers Shortlisted for Young Writer of the Year 2017

The Sunday Times / Peters Fraser + Dunlop Young Writer of the Year Award, in association with the University of Warwick, rewards the best work of fiction, non-fiction or poetry by a British or Irish author aged between 18 and 35. 

This year five distinctive writers, instead of the usual four, have been shortlisted and the list includes three novels, a collection of short stories and a biography.

The Shortlisted Authors

• Minoo Dinshaw - Outlandish Knight – The Byzantine Life of Steven Runciman (Allen Lane).
  A biography of a great and strange British historian.
• Claire North - The End of the Day (Orbit)
  A novel of life, death and everything in between.
• Julianne Pachico - The Lucky Ones (Faber & Faber)
  A debut collection of stories, mostly set in Columbia, brings together the fate of guerrilla soldiers, rich kids rabbits and drug dealers.
• Sally Rooney - Conversations with Friends (Faber & Faber)
  An intimate story of high-risk relationships, youth and love.
• Sara Taylor - The Lauras (Windmill)
  The Lauras explores identity and relationships set against a rolling backdrop of the North American landscape.

This year the prize is being judged by the award-winning novelist and political commentator Elif Shafak and the acclaimed cultural historian and biographer Lucy Hughes-Hallett alongside The Sunday Times literary editor Andrew Holgate. 

Commenting on the shortlist Elif Shafak said "Our wonderful shortlist celebrates the depth and breadth of literature today, reflecting a striking diversity of styles, interests, genres and backgrounds. True, only one of these authors will win the prize in the end, but each of the five shortlisted books has already won our hearts, and we are confident that they will similarly win the hearts of readers worldwide."

£5,000 is given to the overall winner together with a bespoke 10-week residency at the University of Warwick and £400 to each of the four runners-up together with a year-round programme of on-campus and digital support for award alumni on this year’s shortlist.

To celebrate the partnership, the University of Warwick is holding a free one-day festival of events and workshops, bringing together inspirational thinkers, authors, journalists and performers: freeflow will take place on Wednesday, 29 November. More information can be found at warwick.ac.uk/youngwriter. 

You can keep up to date with the award and join the conversation, via: youngwriteraward.com | twitter.com/youngwriteryear