Building Care Services Around the Needs of Clients Leads to Outstanding Rating by CQC

Tigh Sogan care home in Croydon has been rated Outstanding overall by the Care Quality Commission following an inspection in February 2018.

The service provides accommodation and care to people with Learning Disabilities.

They were particularly commended for their approach to managing and reducing challenging behaviour.  Each person was supported to create a ‘personal folder’ where they recorded things which they liked and things they did not like, which could be triggers to challenging behaviour. Staff received regular training, approved by the British Institute of Learning Disabilities, in positive behaviour support. Staff said the training was excellent and that the provider gave on-going support in helping people stay safe. Residents said they felt safe and relatives were in agreement. Staff discussed safeguarding at each team meeting.

The relative of one resident, who had a poor quality of life in their previous placement and refused to engage with people or in any meaningful activities, said: “Our son has got his life back and this has changed our lives too. They’ve done wonders for him here. The progress he has made and the support is outstanding. It’s so person-centred. There are group activities but there are always staff available if he wants to do something else.”

The provider recently began a programme at a local hospice to train staff in understanding how to provide high-quality care to people at the end of their lives. As part of the programme people are supported to consider how they would like to receive care at the end of their lives through involvement with their families.

Key Findings

• The provider had excellent systems in place to support people in relation to behaviours which challenged the service. Assessing needs and implementing consistent ways of working tailored to each person. 
• Staff received training in relation to positive behaviour support and understood people’s needs well.
• Care plans were carefully designed so people's emotional needs, individual preferences and interests were well catered for.  Each person was supported to live a meaningful life despite difficulties they experienced in their day to day lives and previous difficulties in engaging in activities. 
• People had individualised activity programmes in place which met their particular interests and needs very well.  Staff supported people to increase choice and control in their lives through their excellent understanding of people's needs and preferences. 
• People were at reduced risk of social isolation as the provider actively encouraged socialising and building relationships. 
• Systems were in place to reduce the risk of abuse. 
• Staff were well supported with induction, training, supervision and annual appraisal to help them understand their role and responsibilities. 
• The provider identified, assessed and managed risks relating to people’s care as well as to the premises. 
• There were sufficient numbers of staff deployed to support people with each person receiving individual support throughout the day. 
• People received coordinated care when moving between services such as hospital admissions and when newly admitted to the care home. People were supported in relation to their day to day health and to access healthcare services they required. 
• Staff understood people’s communication needs well and adapted their communication for the different individuals. People were encouraged to develop their independent living skills. 
• The registered manager created a positive, encouraging environment for people, staff and relatives who visited the service and had a good understanding of their role and responsibilities. Leadership was visible and capable at all levels and staff also understood their role well. 
• The provider had good governance systems in place to audit and improve the service with frequent checks of the service in line with CQC standards.

On Average University Graduates Earn £10k More Per Year Than Non-Graduates

The latest Graduate Labour Market Statistics from the Department for Education show that, in 2017, English-domiciled graduates and postgraduates had higher employment rates than non-graduates and the average, working-age graduate earned £10,000 per year more than the average non-graduate.

Key Findings

• In 2017, graduates and postgraduates had higher employment rates than nongraduates. 
• Although graduates and postgraduates had similar overall employment rates in 2017, postgraduates had much greater high-skilled employment rates, with 77.8% of all working-age postgraduates in high-skilled employment compared to 65.5% of all working-age graduates. 
• In 2017 the average, working age graduate earned £10,000 more than the average nongraduate, while on average postgraduates earned £6,000 more than graduates. 

Talking about the Department for Education's report, Alistair Jarvis, Chief Executive of Universities UK, said: "These latest figures show that, on average, university graduates continue to earn substantially more than non-graduates and are more likely to be in employment. A university degree remains an excellent investment.

"University graduates are also in increasing demand from employers. The latest annual survey from the Institute of Student Employers revealed that the graduate jobs market is expected to grow this year, with an estimated 11 percent rise in vacancies.

"While graduate salaries are an important factor, we must be careful to avoid using it as the single measure of success in higher education. Many universities specialise in fields such as the arts, the creative industries, nursing and public sector professions that, despite making an essential contribution to society and the economy, pay less on average."

Focus on the Client-Carer Relationship Leads to Outstanding CQC Rating

Home Instead Senior Care, based in Croydon, has been rated Outstanding overall by the Care Quality Commission following an inspection in March 2018.

The service, which looks after older people in their own homes, was rated Outstanding for being caring and responsive. It was rated Good for being safe, effective and well-led.

Clients and their relatives without exception were extremely positive about staff.  One person said: "Staff are all very compassionate and nice." A relative said: "Staff are friendly but professional, I am very impressed." A third relative said: "Staff are very focused which is what I need them to be but also pleasant and friendly. They are positive and they engage with mum."

A member of the management team met with clients and their relatives before they began receiving care to check how they wanted to receive care.  As a result people's care plans were comprehensive and fully reflected their needs.

People were carefully matched with the staff who supported them based on cultural, linguistic, religious or social needs. One relative said: "They found a regular carer who is also from the same country as my family and we share a language as well as a culture. The carer understands our culture she knows exactly how my mum would like to be treated and does so."

Other examples of successful matches included where a person was passionate about sport and enjoyed talking and watching matches with staff and another person who was very religious and enjoyed singing gospel songs with staff.  As a result of this matching, they were able to build trusting relationships together.

People received their care in an unhurried manner. One relative said: "The carers make sure that he goes at his pace." A second relative said: "Staff are gentle and unrushed." The director said how important it was that everybody felt as if they mattered and they made every effort to ensure this. For example, the provider only accepted visits of a minimum of one hour to ensure staff had sufficient time to provide companionship to people. The provider scheduled visits so staff had sufficient time to travel between people and staff told us they did not feel rushed in any way when providing care.

The service took a key role in the local community, establishing strong links with the local hospital. A dementia nurse based in the hospital said the provider had been a "pillar of support to the hospital and the local community". The provider was a member of the Croydon Dementia Action Alliance (CDAA).  The CDAA encourages and supports communities and organisations across Croydon to take practical actions to enable people to live well with dementia.

Debbie Ivanova, CQC’s Deputy Chief Inspector of Adult Social Care, said: “Home Instead Care consistently provides a caring service for its clients and Croydon is yet another example of this.

“I was particularly impressed with the way the provider matched up staff and clients that had similar interests and the way this cemented good relationships between them in a number of instances.”

Society of Authors Challenging Five Fold Rise in NI Payments For Low Paid Authors

In April 2019 National Insurance rules are set for a shakeup, as a result, authors earning less than £6205 a year could see their National Insurance Contributions (NICs) bill increase fivefold.

Writers, illustrators and translators earning less than £6205 per year can currently make voluntary payments of £2.95 in the form of Class 2 National Insurance Contributions (NICs).  From April 2019 self-employed workers earning below £6205 will still be able to make voluntary contributions towards their state pension – but only in the form of Class 3 NICs, which are £14.65 a week.

This adds up to £761.80 per year, a fivefold increase on the Class 2 annual contribution of £153.40. If you earn below £6,205, this will mean a minimum contribution of 12.3% of your income.

Talking about the changes in a recent blog post the Society of Authors (SoA) said "The Government claims that relatively few people will end up making this payment, as they will gain qualifying years for contributory benefits through other means, such as through additional employment or benefits. However, the Government’s own analysis suggests that 100,000 self-employed workers earning less than £6205 a year will end up making these payments of £14.65 a week (2% of a workforce of 5 million).

We are concerned that this change will disproportionately affect authors and other creators who are already struggling financially. Many have an author income below £6205, and some have no other sources of income."

The Society of Authors is busy petitioning HMRC on behalf of authors and illustrators and they met last week to discuss the matter.  As a result of that meeting it has been agreed that the SoAs will submit further evidence on the impact of these proposed changes.  

If you are below state pension age and earn below £6205 per annum from your writing, and if you have no other sources of income, you can contact the SoAs with your testimony by email at tgallagher@societyofauthors.org but do it by Monday 23 April.

GP Practice Previously Rated Good Placed Into Special Measures by CQC

St Lukes Surgery, Hedge End, Southampton has been placed in special measures by the CQC following a deterioration in the quality of its services.

The surgery was inspected following an information security breach that was publicised on their website.

Inspectors found that there was a significant decline in standards and rated the surgery as Inadequate overall, placing it into special measures.

The CQC found there was no longer a registered manager at St Luke’s Surgery and there appeared a general decline in leadership within the practice.

• There was a lack of clear leadership to deliver the practice’s vision and strategy. 
• Staff turnover had resulted in a number of management and clinical vacancies. This resulted in a gap in skills mix for monitoring of long-term conditions such as asthma.
• The practice did not have clear systems to mitigate or manage risk.
• Not all staff had a record of having completed safeguarding training.
• Patients found it difficult to use the appointment system and reported that they were not able to access care when they needed it. 
• There was limited evidence to demonstrate how the practice was responding to concerns raised by patients around accessing the service.

Ruth Rankine, Deputy Chief Inspector of General Practice for the South of England, said: “I find it concerning that the high quality, consistent good care we found at our first inspection has diminished to such as degree. While it is good to see that staff are still providing a caring service there needs to be an overall improvement within the practice for the sake of its patients. As a result of these concerns I have recommended the practice will benefit from being placed into special measures, so the practice can receive the support it needs to improve.

“We will continue to monitor progress and we will inspect again within six months to check whether sufficient improvements have been made. I am hopeful that the practice will do what is required for the sake of their patients but if we find that the service remains inadequate, we will consider taking further enforcement action even if that leads to cancelling its registration.”

SMEs Embracing the Newsletter to Drive Up Sales

Businesses, big and small, are re-evaluating their use of social media, no longer prioritising social media platforms such as Facebook and Twitter and returning to the good old-fashioned e-newsletter as the primary method of communicating with customers.

Social media platforms are busy places and there is growing recognition that you have to fight to be seen, something backed up by research showing that consumers are less engaged with publishers on social media platforms than had been assumed.

Competition for ad space has grown, pushing up prices, and platform algorithms have led to business posts being naturally included in people's feeds as little as five percent of the time.

As a result more and more businesses are turning their focus back onto their mailing lists and electronic newsletters, and it is paying off, with some businesses reporting 60% plus opening rates.

The reappraisal of the newsletter has been driven by a few different factors, from audiences’ desire for a finite regular source of content amid the endless feeds of information, to improvements in newsletter technology helping you target your content.

Given the benefits of an email newsletter that caters to an engaged audience, and the relatively low costs associated with running one, it’s small wonder that so many businesses are attracted to the model.

Making Your Newsletter Work For You

Your newsletter is a direct link to someone who has already said they want to know more - you really are already more than halfway there!

Publish regularly, a news roundup at the start or end of the week or month has been shown to strengthen relationships between businesses and customers - an audience habituated to a branded email in their inbox is a more engaged – and therefore a more valuable audience.

Personalise content, tailor articles to suit the needs of the reader, when customers sign up to your newsletter get them to say what they are interested in (in applications such as MailChimp you can offer a tick box list of areas of interest) and only send them emails about those topics - you only need to receive one or two emails that says nothing to you personally to disengage with a brand.

A study last year from the Reuters Institute for the Study of Journalism found that newsletters whose contents had been personalised by the reader enjoyed almost double the open rate of a more generic email, the contents of which had been dictated by an editor.

Some of the best email newsletters contain original editorial content, not simply repackaged copy from the article to which they link. Include explanations as to why the articles that are curated within the newsletter are of interest to the audience.

Popular newsletters offer an antidote to the constant churn of content and avoid simply pushing products.  They are about building a relationship with your customer, having the sort of conversations you might have had across the counter in your store in days gone by, that build trust and loyalty, which in turn lead to sales. 

It Works!

One of the most prominent – and most successful email newsletters at the time of writing is The New York Times’ Morning Briefing, which has been celebrated for its open rate of between 50 and 60%. Crucially, the newsletter also acts in support of the Times’ subscription model, with subscribers to Times’s free newsletter twice as likely to become paying subscribers as the general public.

Don't Stop There...

Don't be complacent, use every opportunity you can to build your mailing list, sign up sheets and tablets at events, invitations to sign up via other social media outlets and your own website - yes you want to get sales from your activities outside of your mailing list, but get a customer on that list and you will be able to carry the conversation on for even longer!

CQC Reports Independent Acute Hospitals Doing Well But Need to Strengthen Governance

The Care Quality Commission (CQC) has published its analysis of the quality and safety of care provided by independent acute hospitals across England following the inspection of over 200 independent hospitals in England.

Key Findings

• The majority of independent acute hospitals are providing high quality care for their patients. As of 2 January 2018, 62% were rated as good and 8% were rated as outstanding.
• Most patients have prompt access to effective treatment and experience personalised care from highly skilled and caring staff. Of the 206 hospitals inspected, 89% were rated as good and 11% were rated as outstanding for how ‘caring’ their services were.
• The majority of hospitals were also rated as good (86%) or outstanding (7%) for how ‘responsive’ they were. Patients were more likely to have named consultants and the hospitals managed their flow of patients well, which meant that there were few cancellations or delayed admissions or procedures.
• While the report highlights many examples of good care, it also shows variation in quality and clear scope for improvement. Almost a third of hospitals (30%) were rated as requires improvement.
• Safety was where the CQC had the greatest concerns – 41% of hospitals were rated as requires improvement and 1% as inadequate in this area.
• 30% of hospitals were rated as requires improvement and 3% as inadequate for how well-led they were.
• In some cases, the CQC found that a lack of formalised governance procedures meant that hospitals were not effectively monitoring the work of consultants who operate under ‘practising privileges’ – where a consultant clinician works in a hospital but is not a direct employee. Checks to ensure clinicians were only working within their agreed scope of practice were not always taking place. This meant that there was a risk that poor practices were not always picked up or challenged in the way they should be.
• Inspectors also saw that safety procedures were not always fully embedded – for example, where surgeons were not following every step of the World Health Organisation surgical checklist.

Other issues highlighted by CQC include a failure by some hospitals to adequately monitor clinical outcomes to evaluate the effectiveness of the services they were providing, and a lack of preparation for the possibility that a patient’s condition could deteriorate.

Already, the CQC’s actions are driving improvements in care for people and providers have been quick to respond to inspection findings taking on board the CQC’s judgements and proactively addressing areas where further work is needed to improve patient care. Of the 13 hospitals that had been re-inspected, seven had improved. Four of these had improved from an initial rating of inadequate: two going from inadequate to good and two going from inadequate to requires improvement.

Professor Ted Baker, Chief Inspector of Hospitals at the Care Quality Commission said "Much of the care and treatment we have seen at independent acute hospitals is good – and we found that effective leadership at a local level, good staff engagement and a close oversight of the services being provided played a key role in ensuring high quality care.

“However, our inspections also identified concerns around the safety and leadership of some services, often as a result of a lack of safety checks and poor monitoring of risks. Too often, safety was viewed as the responsibility of individual clinicians, rather than a corporate responsibility supported by formal governance processes. Where we found failings, we have been clear that improvements must be made, using our enforcement powers where needed to protect people.

“As the independent quality regulator we hold all providers of healthcare to the same standards regardless of how they are funded. Having inspected all independent acute hospitals in England we now have a comprehensive picture of the quality of care they are providing for the first time – and, importantly, people can use our reports to help them make choices about their treatment.

“Encouragingly, we have seen clear evidence that our regulation is having an impact, with providers taking rapid action in response to our concerns. We want to see this continue and more providers learning from those services that are getting it right.”

NUS Report Shines a Spot Light on Staff-Student Sexual Misconduct in UK Universities

Over the last year, NUS Women’s Officer, Hareem Ghani, has been researching staff-student sexual misconduct in higher education.  She has now published her findings in the NUS's report, Power in the academy: staff sexual misconduct in UK higher education.

Talking about the report Hareem commented "I am thrilled to announce the publication of our ground-breaking report, for a long time, it’s been apparent to many of us who live and work in universities that sexual misconduct is a reality within academia. However, a lack of research in this area, combined with wide-scale institutional failings, meant that we had very little idea of students’ patterns of experience."

Hareem worked on the report with The 1752 Group and sees it as a first step towards understanding the issue of staff-student sexual misconduct.  Hareem continued "Staff-student sexual misconduct needs to be located as part of a continuum of sexual violence in universities and in society more widely.  However, the unique dynamics of the relationship between staff and students in higher education means that there are aspects of sexual misconduct that are specific to this setting."

Key Findings

• More than four in ten respondents experienced at least one instance of sexualised behaviour from staff, and that one in eight had been made to feel uncomfortable by a staff member touching them. 
• Women were much more likely than men to both have experienced misconduct, and to have suffered greater consequences because of it.  Digging further into the stats LGBT+ participants, and LGBT+ women, were even more likely to have experienced misconduct as were postgraduate respondents, and postgraduate women.
• Universities are not responding adequately to report of misconduct.  Of those respondents who reported misconduct to their institution, the vast majority had a negative experience, with 90 percent reporting being let down in some way by the response to their case. 
• The impact of these encounters on students can be significant and long-lasting.  Of those respondents who experienced sexual misconduct, a fifth of women reported losing confidence in themselves; just under fifth experienced mental health problems, 16 percent reported avoiding going to certain parts of campus, and 13 percent felt unable to fulfil work roles at their institution.

Hareem concluded "The significance of these findings cannot be underestimated, and we hope that this research will prompt swift action from higher education institutions. There is still a long way for us to go, but I am proud that the Women’s Campaign and The 1752 Group are taking a lead on this pertinent issue. For too long, these problems have been at best side-lined and at worst silenced by institutions."