CQC Remains Concerned Over the Safety of Online Healthcare Services

The CQC has published a report reflecting on its findings from 55 inspections of online primary care services, such as those that provide GP consultations and prescriptions through independent websites and apps.

The report concludes that the quality of online primary care services has improved over the last 12 months but that further action from providers and the wider system is needed to ensure they are as safe as general practice in physical premises.

Key Findings

• 97% of the providers were meeting the regulations around being ‘caring’. An example of where this has worked well was a company that provided sexual health services online, which offered partner notification services (whereby with the person’s consent, it could confidentially trace their sexual contacts to flag to those who may have been at risk and encourage them to be tested).
• 90% of the providers were meeting the regulations around being ‘responsive’ to people’s needs. Examples the CQC identified included providers that made ‘type talk’ available for patients with hearing loss and one provider responding to a significant uptake in the number of Chinese students requesting services and producing an information leaflet in Mandarin.
• The CQC has found that online consultations have the potential to improve access and convenience for some patients, such as those with physical impairments for whom attending face-to-face appointments could be difficult, those with sensory impairments, and those who live in rural areas and have poor transport links.
• As of 28 February 2018, 43% of the providers the CQC inspected were found not to be providing ‘safe’ care in accordance to the relevant regulations. This is an improvement from 86% not fully meeting these regulations on their first inspections. 

Safety is where CQC found the greatest concerns but also, where the CQC has seen the greatest improvement with some providers even addressing issues on the day of inspection itself; such as, by deciding to no longer prescribe certain medicines or by introducing new policies.  Specific concerns the CQC had included: 

• Inappropriate prescribing of antibiotics, including lowered thresholds for antibiotic prescribing as a physical examination was not possible, 
• prescribing high volumes of opioid-based medicines without talking to the patient’s registered GP,
• unsatisfactory approaches to safeguarding children and those who may not have the mental capacity to understand or consent to a consultation,
• not collecting patient information or sharing information with a patient’s NHS GP, who should have an accurate and up to date record of their previous and current treatments and health problems,
• inappropriate prescribing of medicines for long-term conditions, including failures to monitor the volume of asthma inhalers being prescribed to individuals when their condition should be regularly checked.

Professor Steve Field, Chief Inspector of General Practice at the Care Quality Commission, said “New methods of service delivery that increase access to care and give patients more control over how and when they see a GP have huge potential not only for patients but for the wider health system."

“However, while innovation should be encouraged, it must never come at the expense of quality. As with all health care services, patient safety must be at the heart of all decisions around what kind of care is offered and how it is delivered."

“This is why we have taken action where we have seen risks to patients - and why we have been encouraged to see many providers take note of our findings and make swift improvements to how they operate."

“This way of delivering primary care has an important place in the future of health provision – but it are still evolving. We must all work together – providers by using our inspection findings to learn and improve, and oversight bodies by working together and continuing to have a positive dialogue with providers – to ensure that this model fulfils its promise of accessible, responsive care while ensuring that the care delivered is always safe and high quality.”

Hour Long Multi-Media Poem Wins Ted Hughes Prize for 2017

Ted Hughes Award judges Gillian Allnutt, Lemn Sissay and Sally Beamish have chosen Jay Bernard’s Surge: Side A (Speaking Volumes) as the latest winner of The Poetry Society’s prestigious prize.

Jay Bernard is from London and is the author of three poetry pamphlets: The Red and Yellow Nothing (Ink Sweat & Tears and Café Writers, 2016), English Breakfast (Math Paper Press, 2013), and Your Sign is Cuckoo, Girl (Tall Lighthouse, 2008). 

Surge: Side A is an hour long multi-media performance work.  It investigates the New Cross Fire of 1981, in which thirteen young black people lost their lives in a defining moment in Black British history. It was produced by Speaking Volumes and was performed at the Roundhouse, London, as part of The Last Word Festival 2017. 

Judge Sally Beamish said: “An intensely personal relating of the New Cross massacre; powerful, lyrical and communicated with extraordinary intimacy. I was particularly struck by their drawing of a parallel between the struggle for validation in the black British community, and the poet’s own clarification of identity by transforming their body through surgery. The performances are riveting and the poems are propelled by a strong internal momentum.”

From Surge: Side A by Jay Bernard

Surge 1 

I was so weak, I was sickened, 

I was grieved, I was sad, 

I was everything that’s bad – 

my voice became the glass

breaking in the heat 

I was so sickened and so grieved 

I was so weak – I called

and no-one seemed to call with me 

no-one seemed to know or see 

what I had seen –

I was so sickened and so grieved

and I said to the child I knew 

harboured in the fire – jump 

Yvonne, jump Paul, jump –

I said, I called – jump 

Yvonne, jump Paul, jump

– my voice it was so weak

– Paul, jump – 

so sickened and so grieved.

Confidence Amongst SMEs Increasing

Findings from the latest Federation of Small Business (FSB) Small Business Index indicate a rise in the overall confidence level of small businesses in the UK.

Report Highlights

• More than seven in ten firms expect their performance will either improve (32%) or remain the same (40%) over the next three months, while only one in four (27%) lack confidence about the coming quarter.
• More than two-thirds of firms (67%) reported that revenues are either stable or increasing.
• The proportion of firms planning to increase investment has hit a two-year high (33%).  
• Half (50%) of small businesses expect to expand operations over the coming 12 months.
• Small firms are continuing to hire. The proportion reporting a steady or increased headcount is at its highest since summer 2016 (82%).

Although the overall picture is positive there are some stark variation between sectors.  At one end of scale retail reported a fall to -19% and accommodation and food services -25%.  Whilst at the other end, manufacturers were +33% and professional services & scientific firms +14%. 

International traders remain bullish, with the share of small exporters expecting global sales to increase over the coming three months at a one-year high (42%).

The report found that the domestic economy remains the biggest barrier to small business growth, with more than half (55%) of firms raising it as an issue. Consumer demand (33%), the regulatory burden (28%) and labour costs (21%) are the other most frequently flagged barriers to growth among small firms.

Mike Cherry, FSB National Chairman, said: “After a 2017 dogged by spiralling prices and political uncertainty, it’s good to see small business confidence back in the black. The resilience of the small firms and self-employed entrepreneurs that make up 99 per cent of UK businesses has lifted economic forecasts for the coming 12 months.

”The picture is mixed though – consumer-facing firms are still trying to keep their heads above water after a year of customer belt-tightening and business rates hikes. As a labour-intensive industry, small firms in the retail sector will disproportionately feel the impacts of a rise in the national living wage and auto-enrolment contributions next month.”

“As Brexit negotiations progress, the Government needs to remember that it’s economic growth, consumer demand and labour costs here at home that are on the minds of small business owners day to day.”

Tackling Sexual Misconduct and Harassment of University Students

Universities UK, the representative organisation for the UK's universities, has published its report into the work universities are doing to tackle sexual misconduct and harassment of students.

The new report Changing the Culture: One Year On – based on research carried out by the Leadership Foundation for Higher Education (LFHE) – assesses the sector's progress in England, Wales and Northern Ireland in implementing recommendations from the Universities UK Taskforce's report Changing the Culture.

The study was based on in-depth research with a sample of 20 institutions, designed to reflect the different types of universities.​

Key findings:

• Whilist some signficant progress has been made, it is not consistent across universities.
• The key difference between those universities which have made progress and those which have not, appears to be the level of commitment and drive to tackle these issues by senior leaders.
• Where reports of misconduct and harassment have increased, institutions report that this reflects a change in culture, leading to students feeling more able to report and perhaps more confident that their complaints will be handled appropriately.
• Sharing good practice is key to continuing to make improvements across the sector.
• Tackling hate crime and hate-based harassment tends to have a lower priority status compared with efforts to address student sexual misconduct
• There is less evidence of new prevention and responsive strategies being developed to address staff-to-student sexual misconduct in the same way as those addressing student-to-student misconduct
• Centralised systems and processes for collecting and recording data on sexual misconduct, hate crime and hate based harassment remain underdeveloped areas across this sample
• The HEFCE's Catalyst safeguarding funding of £2.45m has accelerated and supported change across England's higher education sector
• Institutions report barriers to progress in areas including sustainable funding for resources, training for students and staff across larger institutions and maintaining a consistent approach across the sector

Professor Dame Janet Beer, President of Universities UK and Vice-Chancellor of the University of Liverpool, said "It's encouraging to see that significant progress has been made at many universities. Despite this, clearly more needs to be done. There should be a greater focus on tackling staff to student sexual misconduct, hate crime and hate-based harassment.

"Ultimately, a long-term commitment by senior leaders will be vital to ensuring further progress in making our universities safe places to live, work and study. We owe it to our staff and students to accelerate the pace of cultural change."

Jermy Hunt Outlines Vision for the Future of Social Care

Jeremy Hunt outlined the 7 key principles that will guide the Government's thinking ahead of the social care green paper, to be published before the summer of 2018.

His speech ackowledged the pressures being faced by the system with:

• Many families finding it incredibly hard to access the care they want with or without means-tested support from the state.
• Many people employed in the system finding themselves, working too hard as they struggle with fragmented services coming under unprecedented pressure.
• The CQC expressing serious concerns about the state of the adult social care market and the risks of provider exit.  
• Pressures trickling down to the NHS with A&Es becoming overcrowded because hospitals find themselves unable to discharge patients who cannot access social care support packages.

Setting the scene Jeremy Hunt commented "Behind these systemic issues sit many ordinary human beings in a great deal of distress. Families coming to terms with a relative with dementia. Older people living on their own who won’t admit they are lonely. Care home residents with clinical depression, as we know happens in 4 in 10 cases."

The 7 Key Principles

1. Quality
81% of adult social care providers are good or outstanding according to the CQC.  But still too many people experience care that is not of the quality we would all want for our own relatives.  There will be a commitment to tackle poor care with minimum standards enforced throughout the system.

One of the questions the Green Paper will pose is whether we can build on the learning from the introduction of independent Ofsted-style ratings for providers to spread best practice to commissioners as well.

2. Whole-person integrated care
The risk is that too often an individual and their family are passed from pillar to post, giving the same information repeatedly without receiving joined up, personalised care that makes them feel like a valued human being and not just another task on someone else’s to do list.

Users of the social care system should have just one plan covering all their health and social care needs based on a joint assessment by both systems. 

New pilots in Gloucestershire, Lincolnshire and Nottinghamshire will see every person accessing adult social care given a joint health and social care assessment and - critically - a joint health and care and support plan, where needed.

3. Control
What matters to individuals and families is the ability to direct the care they receive and autonomy to lead the lives they want.  Whilst over 90% of older people receive some type of self-directed support, only around 1 in 6 take it as a direct payment with take-up stubbornly low for older people.

The government wants to "turbo-charge" progress on integrated health and care budgets, making them the norm and not the exception when people need ongoing support.

Over the next 2 years in Gloucestershire, Lincolnshire and Nottinghamshire every single person with a joint care plan will also be offered an integrated health and care personal budget.

4. Workforce
Talking about workforce issues Jeremy Hunt said "People who work in care homes, who do home visits, who look after people with care needs with kindness and love in every street in every town – these are our society’s modern-day heroes. Often highly skilled, they are typically also the lowest paid."

"So it is time to do more to promote social care as a career of choice and to ensure there are better opportunities for progression into areas like nursing which span both the health and social care sectors. And we need coherent workforce planning that is better aligned with that now being undertaken by the NHS. Alongside social workers, occupational therapists and nurses in social care we have many care workers who could benefit or be inspired by new progression ladders similar to those that are being developed in the NHS including roles such as associate nurses and nurse degree apprenticeships. These must be as available to those working in social care as in the NHS."

"We have many registered professionals including social workers, occupational therapists and nurses in social care; and many more care workers and other unregistered professions. We need to ensure we have enough people within all of these skilled roles to support people to live the best possible lives. That means making sure that the new routes in to professions that we have developed for those working in the NHS, and the new roles such as nurse associates, also work for those wanting to build their careers in social care."

"We need to recognise that people move between the NHS and social care systems - and will do more so as the 2 systems join up. So part of our thinking must be to think about health and care workforce issues in a joined up way. I can therefore confirm today that later this year we will not now be publishing an ‘NHS 10 year workforce strategy’ – it will be an ‘NHS and social care 10 year workforce strategy’ with the needs of both sectors considered together and fully aligned."

5. Supporting families and carers
Jeremy Hunt said "If we can make it simpler to look after a loved one, if we can make it easier to juggle working and caring responsibilities, if we can encourage volunteering – whether by more flexible working, better employer support or harnessing new technologies, then that is what we should do."

"Over the past months we have been listening to the views of carers so ahead of the Green Paper we will publish an action plan to support them."

6. A sustainable funding model for social care supported by a diverse, vibrant and stable market.
The government will look at how it can prime innovation in the adult social care market, developing the evidence for new models and services, and encouraging new models of care provision to expand at scale.

Specifically looking at the role of housing, including how the very best models that combine a home environment with quality care can be replicated and how we can better support people through well-designed aids and adaptations.

7. Security for all
Families are too often faced with the randomness and unpredictability of care, and the punitive consequences that can come from developing certain conditions over others.

If you develop dementia and require long-term residential care, you are likely to have to use a significant chunk of your savings and the equity in your home to pay for that care. But if you require long-term treatment for cancer you won’t find anything like the same cost.

People’s financial wellbeing in old age ends up defined less by their industry and service during their working lives, and more by the lottery of which illness they get. 

The system needs to includes an element of risk-pooling and the government will be bringing forward ideas as to how to do this alongside the potential costs in the Green Paper.

Instagram Now More Powerful For Authors

As well as following accounts, Instagramers can now follow hashtags.

In the past those wanting to find out about a particular topic would need to regularly remember to search for the topic to find new postings.

Now users can opt to follow hashtags, bringing that content to them, on a more regular basis.

Following a hashtag is just like following a friend:

1. Tap any hashtag (example: #chicklit) you see on Instagram.
2. Tap Follow. 
3. Once you follow a hashtag, you'll see its photos and videos appear in your feed.

For authors, this change increases the likelihood that posts and mentions will be seen by potential new customers, as well as by those you already connect with - and with over 800 million monthly users and 50 million daily users, there are a lot of potential customers out there!

Top Tips:

• Don’t try to make everyone like you. Think about your perfect reader and speak to him or her.
• Link to your author website in your bio.
• Engage with other users.  As with all social media, you can’t just broadcast–you have to interact. This includes engaging with content posted by others and re-posting content.
• Make those hastags predictable - clever hashtags might be funny or ironic, but no one will get the joke if you they can't find you.  Try and include around 5 hashtags in each post, make them short and snappy - #penguin will reach more people than #penguininayellowhat.
• Post regularly, like advertising, Instagram works best when you are able to integrate your brand into potential customers' daily lives.

Lack of Process, Procedure and Management Oversight Leads to Inadequate CQC Rating

A GP practice serving patients in Waltham Forest and Hackney has been rated Inadequate overall by the Care Quality Commission.

Vicarage Road Medical Centre has been rated Inadequate for being safe, effective and well-led. It was rated Requires Improvement for being caring and responsive, after the inspection in November 2017.

The CQC found that:

• Childhood immunisation uptake was below national averages.
• There was no clinical oversight from the GP in the Quality Outcome Framework exception reporting process.
• Arrangements for alternative clinical cover were not always in place.
• The national GP patient survey showed that patients rated services provided by the nurse and access to appointments below the Clinical Commissioning Group (CCG) and national averages.
• The practice did not have up to date personnel records for locum staff members.
• There was minimal management oversight in staff training and completed training such as child safeguarding and infection control was out of date.

However, inspectors did find that staff involved and treated patients with compassion, kindness, dignity and respect. And there was an active patient participation group.

Acting Deputy Chief Inspector of General Practice, Michele Golden, said “We are placing this service in special measures. Services placed in special measures will be inspected again within six months. Special measures will give people who use the service the reassurance that the care they get should improve."

“However, the service will be kept under review and if needed could be escalated to urgent enforcement action.”

Society of Authors Calls For Transparency Over Earnings

Writing in The Bookseller, Nicola Solomon, CEO of the Society of Authors, has challenged trade publishers to adopt a fairer approach when calculating fees, advances and royalties for authors.

In 2013 a study by the Authors’ Licensing & Collecting Society (ALCS) showed professional authors’ typical annual income had fallen by 29%, to £11,000. ALCS is updating the study: and the Society of Authors in urging all authors to take part.

According to their own published data, the profit margins of the big corporate publishers are increasing. In 2008 Simon & Schuster Inc reported a profit margin of 9%; in 2016 it was 16%. Together, Penguin and Random House now record a margin of 16%, almost double what they recorded separately. The Bookseller editor Philip Jones believes that trade publishing is now more profitable than it was, possibly by as much as third - a similar increase in profits to the fall in income authors have suffered.

In the article, Nicola challenges publishers to state in their accounts how much they pay to authors, illustrators and translators in advances, royalties and secondary income.  Her demands include:

• Fair terms. Ahead of EU legislation, all publishers should sign up to Society of Authors CREATOR principles.
• Transparent and clear accounting to show exactly how much publishers pay authors, illustrators and translators.
• Publishers should commit to paying authors a higher proportion of turnover, and increase advances and escalators.
• Redistribution to a wider pool, not just celebrities, but writers from across society. With details of how author share is distributed in company accounts.

The Society of Authors president Philip Pullman commented: “To allow corporate profits to be so high at a time when author earnings are markedly falling is, apart from anything else, shockingly bad husbandry. It’s perfectly possible to make a good profit and pay a fair return to all of those on whose work, after all, everything else depends. But that’s not happening at the moment. I like every individual editor, designer, marketing and publicity person I deal with; but I don’t like what publishers, corporately, are doing to the ecology of the book world. It’s damaging, and it should change.”