Strong and Evolving Policies and Procedures Lead to Outstanding Rating from the CQC

The CQC has found North Shore Nursing home, in Blackpool, to be Outstanding following an inspection in March 2018.

At the time of the inspection North Shore Nursing home was at capacity, providing accommodation and nursing care to 25 people.

North Shore Nursing home is rated Outstanding in all categories.

Report Highlights

• The registered manager was proactive in ensuring people accessed healthcare services quickly. 
• Their pioneering techniques greatly improved people's lives because they assisted staff to implement treatment before problems deteriorated. 
• The management team had exceptional procedures for the preparation of meals, delivery of nutritional support and monitoring of associated needs. 
• People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. 
• Staff maintained up-to-the-minute documentation to assure they continuously met the person's changing capacity and support requirements. 
• The registered manager had an exceptional initiative for training and to assist staff to apply their learning in practice. They used team meetings, handovers, supervision and group discussions to follow training up with observation, question and answer sessions, competency testing and role-play. 
• Staff had a very good grasp of the Human Rights Act 1998 and implemented this in their work. They had relevant training and demonstrated an in-depth awareness of inclusion, discrimination, diversity and prejudice. 
• Staff continuously kept people and their representatives fully informed and involved, which helped them to take ownership of their treatment. 
• Staff frequently evaluated care documents to ensure they were updated to people's changing wishes and health to optimise their end of life experiences. 
• The management team promoted an authentic culture of transparency at North Shore through extensive quality assurance audits and feedback systems. 

Debbie Westhead, Deputy Chief Inspector of Adult Social Care in the North, said “The service engaged in effective staffing levels and skill mixes, this supported them in delivering the high quality care and attention the residents deserve. The proficient communication in the home meant that people’s needs were well known and documented efficiently, which ensured people’s continuity of care.

“Our inspectors were told many times, by residents and their relatives, about how much their health has improved whilst at the service. One resident’s relative told us it ‘should be an example to other homes’ – I agree. The compassion and dignity we witnessed was reinforced by strong and evolving policies and procedures, implemented by devoted and knowledgeable staff.

“We were impressed by the organised, proactive and dedicated management of the service. It was clear that safe high quality person-centred care was the priority. We saw a commitment to continually improving the care being provided by engaging with the residents and their families.

“It is wonderful to see a service embrace innovation and continually develop improvements to enrich people’s lives in care. This service is absolutely Outstanding, well done.”

FSB Campaigning to End Culture of Late Payments In Support of SMEs

Big business has been put on notice by the Federation of Small Businesses (FSB) and warned that they must do more to end late payments, poor payment practice and supply chain bullying that is damaging the UK economy.

A letter from FSB National Chairman, Mike Cherry, to all FTSE 100 companies urges Chairman and CEOs to take immediate action by agreeing to lead the way in stamping out poor payments for good. In the letter FSB National Chairman, Mike Cherry, calls on these companies to work with small businesses to help foster a new payments culture in the UK.

Research from FSB shows the hugely damaging impact these practices have on small firms within supply chains with our data showing that the vast majority (84%) of small firms report being paid late, with a third (33%) saying at least one in four payments they’re owed arrives later than agreed.

A similar proportion (37%) state that agreed payment terms have lengthened in the past two years, hampering cash flow. Only four per cent say payment terms are improving.

The pressure from small business comes after the release of Parliamentary Joint Select Committee report on the collapse of Carillion published last week. The report laid bare the substantial failures at the company including the squeezing of its suppliers, and the frailty of the Prompt Payment Code.

The FSB is calling for a non-executive Director on Boards to be given a specific responsibility for good supply chain practice including making sure the firm is opting to follow best practice and lead the way, not just doing the absolute minimum or the best it can get away with, and so still squeezing suppliers to improve the firm’s cash-flow.

FSB National Chairman Mike Cherry, said: “The poor payment practices that run rampant through UK supply chains is a national disgrace with the country falling behind almost all other industrialised nations in our ability to pay small businesses on time.

“These practices are putting small businesses at risk forcing many to turn to personal credit cards or overdrafts just to survive. Sadly, we estimate late payments lead to 50,000 small businesses a year closing their doors, costing the economy £2.5 billion annually.

“We can only end the late payments crisis and poor payment practices when we see a fundamental cultural shift in the boardrooms of big business, with those at the very top showing a willingness to address the issue and be accountable for their payment practices.”

Select Committee Looking at Barriers to Accessing Work Experience for Students and Young People

The House of Commons Youth Select Committee has launched a new inquiry into barriers to work experience.

The Committee is calling for evidence from a wide range of witnesses, including businesses and charities, as well as students and young people who have been directly affected by these barriers.

The announcement comes as a YouGov poll reveals more than two-thirds of young people (71 per cent) are expecting it to be tougher to find a job in 2030 with 58 per cent of all 11-18 year olds citing a lack of work experience as a barrier.

On the agenda

This year, the committee will look at issues including:

• What does good quality work experience look like? 
• What do young people and businesses expect to get from it? 
• How important is good quality work experience to successful industrial strategy?
• What evidence is there that work experience boosts social mobility? 

The Youth Select Committee call for evidence closes on Monday 18th June 2018 and the Committee will hold oral evidence sessions in the House of Commons in July.

Who can submit evidence?

The Committee welcomes submissions from a wide range of stakeholders, including students, young people and the organisations that support them, businesses, universities and schools.

The Committee is particularly interested in hearing about the differing experiences of groups of students and young people experience in making the most of work experience (eg. due to ethnicity, gender, disability, socioeconomic background and geographic location) and how these might be overcome.

Submissions from students and young people are invited to answer any of the following questions:

• What does “good quality work experience” look like? 
• What do young people and businesses expect to get from it? 
• How important is good quality work experience to a successful industrial strategy?
• What evidence is there that work experience boosts social mobility? 
• How do differences between young people (eg. geographic location, socioeconomic background, ethnicity, disability) affect the work experience opportunities they people have?
• How could resources to help young people find out about and access work experience be improved? 

Evidence can be submitted by contacting the British Youth Council via email here.

Those interested can also submit evidence directly to Parliament via post to Clerk of the Youth Select Committee c/o Work and Pensions Committee, House of Commons, SW1A 0AA.

CQC Local System Review of Cumbria Highlights Inconsistent Implementation of Joint Working Strategy

The Care Quality Commission has published its findings following a local system review of Cumbria. This report is one of 20 targeted reviews of local authority areas looking specifically at how people move through the health and social care system, with a focus on how services work together.

The reviews look at how hospitals, community health services, GP practices, care homes and home care agencies work together to provide seamless care for older people living in a local area. The review considered how the system was performing for people aged 65 and more, focusing particularly on typical pressure points.

CQC reviewers found that older people in Cumbria had inconsistent experiences of health and social care. While the organisations involved do have a health and wellbeing strategy and a vision for the whole of Cumbria, there was inconsistency in how the strategy was interpreted and how services were delivered.

• There are Cumbria two sustainability and transformation partnerships (STPs) and two clinical commissioning groups, for the north and south of the county. The STP plans differed in their interpretation of the health and wellbeing strategy and there were no specific links between the two plans.
• The vision for the health and social care system was that services across the whole of Cumbria would be delivered through 15 integrated care communities which would tailor services to the needs of people living in each local area. This approach was viewed positively across the system but the integrated care communities were newly established and at different stages of maturity in different areas.
• People waiting to be discharged from hospital in Cumbria did not always have a positive experience. Some people experienced long delays because of hold-ups in the assessment process, because home care packages were not available, and owing to a shortage of suitable care home placements.
• There had been some recent improvements with senior health and social care leaders working together in reducing delays, but it was too early to tell whether these improvements would be sustained in the longer term. 
• In primary care, CQC saw there was excellent leadership, especially in the south that was helping drive change and improvement at Integrated Care Community level.
• The system had not resolved the key challenge of ensuring that a suitably skilled health and social care workforce was available in sufficient numbers to meet the needs of local people.
• The system needs to work better with independent care providers and with voluntary and community sector services, which play a vital role in keeping people well and out of hospital.
• Other barriers to integration persisted, such as separate ICT systems that led to difficulties in information sharing and duplication of effort.

Professor Steve Field, Chief Inspector of Primary Care Services, said “It is clear that across Cumbria system leaders are keen to build relationships, and improve how they worked together. However, this work is at an early stage and is fragile.

“We could see that the implementation of the health and wellbeing strategy was leading to pockets of progress, with initiatives preventing people from being admitted to hospital unnecessarily and being supported to stay well in their own home.

“However, we found there was variation between how each integrated care community operated, and significant work was needed to ensure that people across the county consistently experienced high-quality care services that met their needs. This would involve more robust planning, governance and performance measures.

“The health and wellbeing strategy, although focusing on improvements to long-standing issues such as keeping people out of hospital avoidance and maintaining people at home, was reactive rather than proactive. This was a missed opportunity to think more creatively about meeting the needs of a diverse and often rural community.

“While it is encouraging to see plans being developed and it is clear that health and social care professionals have real desire to join-up services, the system is very early in its journey towards integration.”

HMRC Working With Online Marketplaces to Tackle VAT Fraud

HMRC has asked all online marketplaces operating in the UK to sign an agreement to help tackle online VAT fraud and errors taking place on their platforms in a bid to make trading fairer for law-abiding businesses, big and small, who share trading platforms with less scrupulous companies.

Online marketplaces have a responsibility to ensure their sellers understand the tax rules and prevent fraud from happening on their watch.

To assist HMRC in tackling online VAT fraud and error, the agreement asks online marketplaces to commit to:

• educating online sellers from the UK and abroad about their VAT obligations in the UK either via their own help and support or by directing them to HMRC’s GOV.UK guidance
• responding swiftly when notified by HMRC that sellers are not playing by the VAT rules, and setting up a system to take appropriate action 
• finding a suitable and lawful way to provide HMRC with information about their sellers, when requested 

HMRC will publish the list of all online marketplaces that sign up to this agreement. If an online marketplace that signs the agreement fails to meet the commitments, HMRC will remove them from the list.

Mel Stride, the Financial Secretary to the Treasury, said "The growth of online marketplaces has helped many businesses to sell more products across the UK and has contributed greatly to the economy.

However, there is a small minority of sellers not paying their fair share of tax, and we’re committed to working with marketplaces on multiple levels to tackle tax evasion."

This agreement builds on world-leading powers, known by the term joint and several liability (JSL) rules, which hold online marketplaces accountable for VAT fraud committed by sellers on their platforms.  These were first introduced in September 2016 and were strengthened further in March 2018.  Only time will tell if these changes will be enough to level to playing field when selling online.

Health Insurers Agree to Share Data on Independent Healthcare Providers With CQC

The CQC has set out plans to work more closely with four health insurers AXA, BUPA, AVIVA and Vitality in new Memorandum of Understanding (MoU) agreements.

These agreements represent a public commitment from the health insurers to share information with the CQC about the quality and safety of independent healthcare services. The CQC will use this information to improve how it monitors quality and safety in these services.

Examples of the types of information that will be considered for sharing with CQC include:

• Claimants feedback of their experiences of care, including complaints
• Patient safety risks
• Evidence of emerging themes which may be indicative of a wider safety issue across a hospital or provider group
• Outcomes of insurer visits to services that identify safety issues
• Poor clinical treatment or poor clinical outcomes for patients

The information sharing agreements will also cover information about good practice and improvements in care as well as highlighting issues of concern.

CQC Places Coventry Care Service in Special Measures Following Significant Risk Management Failures

Following its latest inspection the Care Quality Commission (CQC) has placed RNIB Pears Centre for Specialist Learning; 5 Pears Court into special measures and rated it as Inadequate overall.

The children’s home at Five Pears Court is one of a group of specialist built bungalows at the Pears Centre in Ash Green, Coventry. The centre provides care for children and young people up to the age of nineteen and there is a school and accommodation for children attending the school on the same site, which is regulated by Ofsted.

The CQC carried out this inspection - following concerns raised by Ofsted about the part of the facility it regulates.

At the time of CQC’s first two visits during this inspection four children or young people lived at 5 Pears Court, but by the time of the second visit, on 5 April, one child had been removed from the service by commissioners, due to concerns surrounding their care and welfare.

Key Concerns:

• The Provider’s Information Return (PIR) did not reflect the findings of the inspection.
• The CQC found safeguarding concerns were not always recognised by staff and managers when incidents occurred at Bungalow 5. 
• Staff and managers had not received the appropriate level of safeguarding training to meet the needs of children and young people at the home. 
• Risks to people's health and wellbeing were not always identified, and risk management plans were not always in place to instruct staff on how they should manage risks to people consistently and safely. 
• There were not always sufficient qualified and trained staff on duty to care for children and young people safely, and to meet their social needs. 
• There was a lack of leadership for staff at the home, including clinical leadership. 
• The CQC found there was no current analysis and overview of accidents, incidents, complaints, feedback and safeguarding concerns at the home to assess whether any trends or patterns were identified and future risks could be mitigated. 
• The registered manager and provider did not fully understand their responsibility to comply with the requirements of the Mental Capacity Act 2005 (MCA) and work within the principles of this. 
• Children and young people were not always supported in a way that respected their privacy and dignity. 
• Children and young people were not always offered activities and social experiences that met their requirements and social needs. 
• Quality monitoring procedures needed improvement to ensure these were undertaken regularly, to monitor service provision. 

Maggie Hannelly, CQC’s Head of Inspection for Adult Social Care in the central region said “Inspectors found the service was failing to provide safe care. Risks to people’s health and wellbeing were not always identified, and risk management plans were not always available to instruct staff on how they should manage risks to people consistently and safely.

“There were not always sufficient qualified and trained staff on duty to care for children and young people safely and we were concerned about a lack of strong leadership at the service. As a result of our findings, the service has been rated Inadequate and placed into special measures.

“The service must ensure it takes robust action to ensure improvements are made and we will return to carry out further inspections.”

Authors Urged to Write to Government Over PLR for Ebooks

The Society of Authors campaign for PLR on ebooks has stepped up a notch with a request going out to all authors to lobby the Secretary of State for Digital, Culture, Media and Sport for urgent action.

Last year, following lobbying from authors and illustrators, and legal cases in Europe, the government agreed to extend PLR to ebooks.  However there is concern that the Government has not taken the necessary action to implement the necessary changes. An additional piece of secondary legislation needs to be passed, which the Government committed to completing by 1 July 2018, so that the first in arrears payments could be made by February 2020.

Talking about the issue the Society of Authors said "We are calling on our members to write to Matt Hancock, the Secretary of State for Digital, Culture, Media and Sport. We have drafted a template letter below, but feel free to edit and personalise this as you see fit. Please send the email to enquiries@culture.gov.uk and copy in tgallagher@societyofauthors.org."


The Rt Hon Matt Hancock MP

Secretary of State for Digital, Culture, Media and Sport

By email

Dear Mr Hancock,

I am writing to ask you to ensure that there is no delay in implementing the extension of Public Lending Right (PLR) to e-books.

Legislation to extend PLR to e-books was passed as part of the Digital Economy Act 2017. As an author [or illustrator/editor/poet etc as appropriate] and a member of the Society of Authors, I wholeheartedly welcome this reform. PLR provides me with a modest but important payment (around 7p) each time one of my books is borrowed from a public library, and it is right that legislation has caught up with advances in technology and PLR extended to e-books.

However I am concerned to learn that the Government has not yet taken the necessary action to implement the change. As you’ll be aware, an additional piece of secondary legislation needs to be passed for the change to come into effect. The Government committed to completing this by 1 July 2018, so that the first in arrears payments could be made by February 2020.

So far no such secondary legislation has been laid before Parliament. I am concerned that we are running out of time for this legislation to be passed and the reform implemented by 1 July 2018.

I know that you were the Minister responsible for taking the Digital Economy Act through Parliament, in your previous role as Minister of State for Digital and Culture. At the Society of Authors’ summer party last year, you emphasised your commitment to supporting authors’ rights, including through the extension of PLR to e-books.

I would therefore be grateful if you could update me on the progress that has been made in implementing this change, and commit to ensuring that it comes into force by 1 July 2018.

I look forward to hearing from you.

For advice and guidance on managing PLR visit the Society of Authors website - click here.