A Dash of quality

 

 

There have been a flurry of reports in recent weeks!

Dr Penny Dash’s review of patient safety across the health and care landscape may not yet have made it to the top of your reading list.

This is a report with ten findings, five conclusions and nine recommendations spread out over 175 pages so you could be forgiven for not ploughing your way through it!

Focusing on social care

While adult social care had not been the primary focus of this review, the review had been struck by the lack of national attention to the quality of social care.

In light of that their tenth finding is that there is insufficient focus on developing a national strategy for quality of social care. In particular:

• as it pertains to outcome indicators
• how much less data there is about quality of care in social care
• the lack of agreement as to the metrics that would best define and describe quality in adult social care

At a national level, the review was surprised to find no clear strategy or plans to drive improvements in quality to address the significant proportion of falls and medicine prescribing and dispensing errors.

The review noted that:

• Whilst the Adult Social Care Outcomes Framework does bring together some indicators, these are only published at a local authority level on an annual basis.

 

• Local authorities are not required to submit data nationally on complaints or feedback. National numbers of complaints are only analysed by the Local Government and Social Care Ombudsman for the cases that reach them.

 

• There is no data collected nationally from providers on e.g. missed visits in domiciliary care, falls, UTIs, bed sores and other clinical indicators.

 

• While the Personal Social Services Annual Social Care Survey does provide key performance indicators of user experience, it only covers users of local authority-funded care and cannot be mapped to individual provider level.

The review was not clear how best practice is disseminated among providers. It did, however, specially mention the outcomes of Care England and Stow Healthcare’s ‘decaf by default’ research.

However, the review did say that adult social care providers clearly recognise the importance of high-quality care, placing considerable emphasis on ensuring quality and acknowledging the role of CQC in assessing care quality.

Key recommendations

Recommendation 7: Reinforce the responsibility and accountability of commissioners and providers in the delivery and assurance of high quality care. 

In social care, particularly, the review recommends that a more strategic approach to commissioning is required, including better use of framework agreements (with fewer providers) and widespread use of outcomes-based commissioning. They are of the view that this should drive greater quality of care for individuals and allow for greater levels of innovation in providers.

Recommendation 9: There should be a national strategy for quality in adult social care, underpinned by clear evidence.

The review recognises that adult social care functions differently to healthcare.

However, within the complex delivery chain, they conclude that there is an opportunity to set out ‘what good looks like’ and:

• develop and agree a set of metrics to assess quality of care (outputs and outcomes);
• agree how to disseminate best practice; and
• ensure appropriate governance structures, systems and processes are in place across all providers.

This recommendation states that consideration should be given to consistent data sets, which all social care providers should collate to ensure a clear and consistent approach to data management across health and social care.

Further opportunities to ensure effective commissioning of adult social care, as set out in the previous review into the operational effectiveness of CQC, should also be considered.

Clearly a national strategy for quality of social care will need to align with or be embedded into the Casey Commission.

Final thoughts

So perhaps more in this review for social care providers than might have initially been anticipated.

If you’d like to discuss any of the issues raised in this article, please contact Jill Mason, partner and head of health and care at Mills & Reeve.