The State of Care Report 2019

CQC State of Care report 2020

Obviously, this year’s edition is particularly important given that it is the first one to deal with the impact that the corona virus has had on the sector and how that may have affected things.

The report was split into 4 different sections2), the first one was about what the quality of care was like before the pandemic, the second one covers the impact of the covid 19, the third one is about collaboration between partners and the fourth and final section is about looking forward, the challenges and opportunities ahead

Quality of care before the pandemic

Up to the 31st March 2020 the care received in England was mostly of a good quality, 80% of adult social care services were rated as good and 5% as outstanding (31 July 2019: 80%, 4%). While it is clear that care providers were able to maintain the quality of care they provided, it is also clear that there was by and large no improvement overall. They did, however, warn that Adult social care remains very fragile, even before the pandemic, they said that the failure to find a consensus for a future funding model continues to drive instability in this sector, and they pointed to an urgent need for Parliament and government to make this a priority.

Statistics from 5 years worth of CQC State of Care Reports detailing the variation in Adult Social Care ratings. 3) Some of the figures have been rounded up for calculation purposes and as a result some totals may be over 100%.

While the percentage of care companies rated Good or outstanding has been on the increase since 2015 the presumption is that this is due to the fact the any that have previously been rated either inadequate or poor have either improved or gone out of business. As well as an increase in funding to help companies improve they can also drive efficiencies through the adoption of a more digital approach.

THE impact of Covid-19 on care delivery

As the pandemic gathered pace, health and care staff across all roles and services showed resilience under unprecedented pressures and adapted quickly to work in different ways to keep people safe. Adult social care providers and staff have had to balance the priority of reducing the risk of COVID-19 transmission in services with the importance of maintaining a focus on the needs and rights of individuals in their care. Many services have used creative solutions to maintain social contact while still observing physical distancing, using video calling equipment so that the families and friends of people receiving care were stable able to see and speak to their loved ones. There was also mention of a homecare provider has been using tablet computers to record baseline observations of people using its service. Monitoring temperatures and vital signs has helped to identify early signs of infection, enabling them to apply 52 additional social distancing measures and to use consistent care teams to help limit any potential spread of the virus.

How digital solutions and technology can enhance collaboration

In part of section 3 CQC talked about digital solutions and technology, and they looked at initiatives in responding to COVID-19 and the impact they have had in terms of

organisations working together. They felt that some things has allowed oversight, advice, online prescribing, and data-driven decisionmaking around service delivery, and aided information sharing – including individual patient records and shared treatment plans. However, IT systems were sometimes a barrier – not all services had a digital presence, and not all people had online access. There were some concerns about the pace at which systems were implemented and some staff still didn’t feel confident using the new digital systems. Among the main reflections across all of their reviews, there is a call for further

development of a common integrated care record across care areas, with national support, across the system. People say this would enable much better information sharing and collaboration.

The challenges and opportunities ahead

From a challenging point of view, the impact of COVID-19 on adult social care has been severe. Care homes in particular have borne the brunt of a disease that disproportionately affects older people and those with multiple conditions and care needs. Adult social care staff have worked hard to keep people safe, but the sector, already fragile, has faced significant challenges. The final part of the report talked about how the pandemic had caused people to work together, and at pace, and asked that this continues to happen right across the country.

A Care Management Software – Simplifying the Management of Care

At Fastroi, we believe that Health and Social Care companies deserve the latest digital tools to help them deliver a higher quality of care with greater accountability. Our fully integrated system allows management a better overview of the operations of their business, while allowing their employees to be more focused on care work. 

Real-Time Care™ is one of the most comprehensive tools available to Care organisations, allowing them to develop a more efficient, higher quality service by using a single integrated platform. RTC™ can bring about process improvements that result in better CQC ratings.


  2. – pages 17, 23, 33, 36, 51, 52, 75, 84, 91
  3. Reference: 2020, 2018/19: P34, 2017: P55,2016: P19
White Paper: Why Should I Use Care Management Software?

New White Paper: Why Should I Use Care Management Software?

Better Tools, Better Care

This is obviously a very personal issue and so we didn’t want to simply write a ten page feature list. Now more than ever, working in care requires an emotional investment and the more time we spend doing the job, the more valuable our experience becomes. Alongside the extraordinary commitment and dedication of care staff, we must support them with the right tools. That’s where Fastroi comes in.  We want to give care companies the best tools to improve the level of care they provide. So instead of listing off a bunch of features, we have put together some interesting analogies and stories to try and explain some of the principles behind products like Fastroi’s Real-Time Care™.

Puzzles Books and Pictures

Managing care has historically been a very labour intensive activity. Staff rostering, scheduling and invoicing are just a few examples of admin tasks that can swallow up staff time and money. In one example, we look at how using the traditional pen and paper system for planning the staff rostas can be like a popular tea break puzzle. We also make the link between how in the absence of a single tool that keeps all of the activity within one secure location, staff needing to use different, unconnected, tools can seem like the work of an early 20th century novelty artist. Removing the complexity of the old pen and paper systems and providing staff with all of the information that they need within one easy to use tool is the only way to reduce mistakes and ensure that the care we provide is of a consistent quality. At the same time we look at how the systems make life easier for the care manager by giving them the ability to plan, report and monitor all of the activities that they are responsible for as well as creating a safe environment for everyone.

Compliance and Security

We also examine several aspects of care management software that are vital in today’s connected society, namely compliance and security. One factor is the way that we employ role based access control to ensure that both staff and client data is only available to those with the appropriate clearance to do so. This makes it simple to see who has done what and when. This kind of digital trail is just another way that we can ensure the safety of the service users and the care staff by ensuring that everything is recorded.

Reducing Failures in Care

Ensuring that both staff and those we care for are protected through the use of better tools is vital. By providing staff with a little more information, we can also make them feel more secure and remove the fear of the unknown. Doing this will also improve the morale of the workers which will lead to improvements in staff retention. The white paper should answer many of the questions that you might have if you are thinking about starting to use an electronic based care system. We would urge you to download it and get in contact with us once you have read it. The simple reality is that any Care Management Software is an improvement on the old pen and paper methods, but the benefits of Real-Time Care™ from Fastroi make it one of the best solutions on the market. You can download our latest white paper here.
The Humble Checklist and its Use in Domiciliary Care

The Humble Checklist and its Use in Domiciliary Care

Lessons from Disaster

Major Pete Hill was the chief test pilot of the US Army Air Corps and he had the responsibility of testing the plane. As Major Hill took off, he must have realised something was wrong quite quickly. He wasn’t able to level off the plane and it kept on climbing until it quickly stalled and fell back to Earth killing all on board. Boeing carried out a meticulous investigation into the crash and they found that the plane had no mechanical faults but that the pilot had forgotten to unlock the elevator control flaps. This meant that they were locked in place making it impossible to level off the plane after take off. In response to this, Boeing created something that would change the airline industry. It wasn’t more training or more technology that was needed. After all, Major Hill was one of the most experienced and well trained pilots of the day. The problem was that the pilots had become overwhelmed by the complexity of what they were doing. Simply put, humans are fallible and prone to forgetting things. So in order to resolve this Boeing created the ‘Before Flight Checklist’ and it led to such a significant improvement in aircraft safety.

Surgical Checklists

This story was told by Dr. Atul Gawande in his book ‘The Checklist Manifesto’. Dr. Gawande developed a Surgical Safety Checklist in 6 hospitals around the world ranging from the UK, Tanzania, Canada and the Philippines. The results were impressive. Postoperative complications and death rates both rates fell by 36 percent on average. Dr. Gawande realised that the levels of complexity that had developed in medicine meant that there was more specialisation. This meant that there was more team activity for every case than in the 1930’s, when a single Doctor would manage the treatment with the support of a small nursing team.

‘Confirm – Do’ Checklists give Peace of Mind

So with a well written checklist, we can see that significant improvements can be achieved not only in the way individuals work but also in teams. With Fastroi’s Real-Time Care™ we were able to implement checklists into the domiciliary and residential care system – While we call them task lists in RTC, they are essentially checklists for the care workers to ensure that nothing is forgotten. We understand the power that taking the pressure off of care workers and placing it within the tools and processes can have on staff. As with any activity, if we record it, then we can prove that it happened. Having this kind of checklist built into Care Management Software, we are able to provide the care staff the reassurance that everything they need to do during a visit will be presented to them in the form of a task list which can be customised for every visit. As every task is confirmed as ‘done’, it is saved on to the server so that an electronic record of the visit exists which can then be used to evidence what was done during the visit.

Where an electronic task list can be superior to a paper based one is in the level of information and detail that can be incorporated. We can add information about the clients needs, wants and requirements so that it becomes truly person centred. The checklist has changed the lives of millions of people from aircraft passengers to patients in operating rooms and their families. The beauty of the checklist is that it also benefits the airlines and the engineers who prepare the planes and the surgeons, nurses and other OR staff who no longer have to worry about forgetting a critical activity brought about by unmanageable complexity.

By skillfully designing the checklists into the tools that are being used for reporting, recording and planning we can reduce the chances of mistakes being made due to staff being under pressure. Less mistakes means greater quality, greater quality means better care.

5 Top Tips to Providing Better Care

5 Top Tips to Providing Better Care

If you are, then it might be time to consider moving to a digital solution. Care Management Software to be precise. If you’re not sure what this means, then we have put together these 5 Top Tips for providing better care with Real-Time Care from Fastroi.

Step 1. Analyse your Current Situation

Running any care business is not easy. Margins are tight, the pressure to give the best care possible is high and above all, you are responsible for caring for people’s loved ones. However, it is worth taking some time out to look at the way your business is being run. Analyse the information that the CQC have provided you in their reports. It’s really valuable to have this kind of objective feedback! How have their ratings changed over different reports? Have you had good reports followed by not so good ones? Have you struggled to maintain the high standards you hope for? Is your business still being run using a pen and paper? If an incident happens, how do you modify the way you work in order to prevent it from ever occurring again? How do you communicate with your staff, customers, their relatives or other agencies?

Step 2. Identify the Process Issues

If you have identified the areas where your business is struggling to maintain a high level of care, it is time to look at the ways your care business works. Many times we are so busy with our work, that we don’t even realize that many of the activities we do on a regular basis are simply process related tasks. We do them because we have always done them. Whether this is preparing the weekly staff rosters, writing up reports or even holding a weekly or daily staff meeting that highlights any issues. All of these activities and others, take time away from the main activity of caring for people.

Step 3. Take Steps to Control those Processes

There are many ways that an organisation can improve their processes, but one of the things that we have found is that people are often being expected to bear the burden of poor processes. By this we mean that instead of automating basic tasks such as rostering, invoicing or reporting, the staff have to carry this additional burden on top of their regular duties. This are two consequences to this. First, the staff feel that most of their time is spent on paperwork or other admin tasks and secondly, the staff spend less time away from the things they should be doing – namely caring for others. The result of this is reduced productivity and a higher risk of mistakes.

Step 4. Automate

As we saw in the previous step, poor process control leads us to reduced productivity and a higher risk of mistakes. Investing in automation can be one of the biggest game changers to improving the performance of a care service. Now we don’t mean having robots taking the place of care staff. What we mean by automation, is the idea that many of the tasks that are still being done by staff using pen and paper can be done much more efficiently using a digital based solution. We still want to see people in the care roles, looking after others, but we don’t want to see them stretched to breaking point because of tasks that can easily be carried out. Imagine if a report on a domiciliary care visit could be completed and saved before the carer has started the engine on their car? Any issues could be immediately flagged up and dealt with instead of waiting until later in the day for the report to be submitted. Imagine being able to automatically plan your staff rosters and have the flexibility to adjust is a staff member calls in sick. These are just some of the basic things the are possible. As you dig deeper into the possibilities, it becomes clear that care management software can address many of the issues that bring down many CQC ratings. Connected care plans, lone worker protection, medication control, alerts to name but a few. In fact, by automating many of the tasks, you could start to regain control of your processes and improve the overall quality of care!

Step 5. Arrange a Demo!

Fastroi have been developing our ‘Real-Time Care’ – care management software in Finland for over 15 years. In fact, we have about a 60% market share there. From large cities and municipalities to small privately run family businesses, we are the natural choice for many. We are now growing our UK side of the business and we are seeing the same levels of interest as back home.

We believe that every residential and domiciliary care service deserves to be rated as ‘Outstanding’ because of this, we would like to offer you a free demo of the product and a consultation about how Fastroi can help you become ‘Outstanding’.

You can also meet our team in Birmingham at the Dementia Care and Nursing Home event on the 26th and 27th of March.

Digital Solutions and the Path to Becoming Outstanding

The CQC State of Care Report. 2017/18 – Part 2.

Maintaining Standards is Not Easy

The original rating clearly has a significant bearing on this statistic. If the original rating were Good or Outstanding, then no change is a perfectly satisfactory result. In addition to this, services receiving a poor original rating have a clear incentive to improve. For services graded as Inadequate, there was an 89% improvement in the overall ratings, which by any standards is impressive.

The question is – What happens next? The data shows that 25% of services rated as either Good or Outstanding declined during the following year.  So the ability of the services to maintain their ratings from year to year is an important factor which is of real interest to us at Fastroi. The report acknowledges that high quality of care is not easily maintained and cites several areas that might lead to a ratings decline.

58% – No change
25% – Improved
17% Decline

Source: CQC State of Health Care and Adult Social Care in England Report 2017/2018. P31 Fig. 1.7
State of Care 2017/18: Full report PDF | 3.73 MB

A lack of leadership and governance is one of the major causes of declining quality, since the systems are not in place to monitor quality levels. Failures in medicinal adherence also puts customer safety at risk. Continuity of management and staffing concerns also carries risks for quality. Reliance upon short term agency workers is not cost efficient and also lowers the continuity of care that is so important to many customers. The report told the story of one person who received 42 different care workers in 1 week.  Staff retention levels are also affected by poor training and development, low wages with zero hours contracts and difficult working conditions. Poor relations between providers and managers have lead to out of date care plans, missing information, poor training and support for new staff and bullying to admit more customers.

Care Management Software Makes Helps Maintain Standards

It is clear that many of these services cannot be using any kind of Care Management Software. They may be able to make short term improvements and deliver high quality care for a short time, but they will always be susceptible to external factors. If changes creep in slowly, then they may be difficult to control and may only be spotted at the next inspection. If they occur quickly, then the results can be catastrophic.

Care Management Software is so effective because it is the tool that controls the process, not the person. This is significant because all of the issues mentioned above could not happen if the processes were properly controlled. It should be very easy for a manager to use the Care Management System to present all of the information about staffing levels, bed availability to service owners making the service less susceptible to influence or pressure. Staffing would become more stable, with staff feeling more comfortable in their positions and not being asked to run the service over capacity. This in turn will lead to higher retention levels and less agency staff being needed, lower costs, higher profits and a much less stressful environment. The result – Higher Quality of Care.

By running a Care Management System that controls the processes, services can improve and maintain the quality of their care from year to year. Clearly, achieving a Good or Outstanding CQC rating is not easy, and maintaining the rating also has its challenges. Employing a Care management System such as Real-Time Care from Fastroi, gives service providers and their staff the right tools to achieve Outstanding results for years to come.

Digital Transformation of Social and Health Care is Already Happening in Finland

Digital Transformation of Social and Health Care is Already Happening in Finland

I am lucky. I can’t remember the last time I went to the doctors, let alone the reason I needed to go. I try to keep fit, eat relatively healthy, don’t drink to excess and don’t smoke. I do have to take the kids to the doctors on occasion but for a long time I have not needed to see a doctor for myself.

So when we were recently discussing the integration of Real-Time Care™ into the Finnish Kanta system, I thought that it would be a good opportunity to take a look at what it does and why integrating with it is so important for Fastroi.

Digital Transformation in Progress

Kanta is a nationwide system that gives every citizen or resident of Finland the chance to access their medical records, manage their medication and prescriptions and share their requests for treatment and organ donation. The idea is to create a portal that securely connects the health service across all regions, municipalities and private care providers. There will also be a feature that allows you to upload any health or wellbeing data from smartphone apps.

Logging in to the system for the first time was simple and most importantly, very familiar. In Finland most banking activities can now be done online. To do this, there is a very secure authentication system that allows us to do this called Tupas. What makes the Tupas banking system so smart is that you can use your banking login system to log into many other official services in Finland. These include the tax office, insurance companies, other commercial systems and of course, Kanta. This universal familiarity develops trust in all of the systems that use it. When you go to the Kanta page, you are directed to your bank login service which requires a user number and a pin  to login. The pin number can be authenticated using a seperate app on your smartphone or through a disposable pin system where numbers are crossed off a card as they are used. Once the account is authenticated, you are taken to your personal Kanta pages.

When was your last Tetanus jab?

As I looked through the various pages for the first time, I saw my own rather sparse medical history. I was reminded that almost 2 years ago I visited the doctors to receive treatment for a dog bite. I was able to read the report from the visit to the doctors and found the tetanus jab and antibiotics they gave me. (Who remembers when they had their last tetanus jab?) There was the prescription with all all of the instructions, dosage, the pharmacy I went to and even the price of the medicine. If I had needed to have a repeat prescription, I would have been able to order it online as well.

I can also see my children’s pages as well, and there are even sections for a living will, organ donation (duly updated!) and a section that gives consent and authorisation to use the information.

High Quality Integrations are Key to Kanta’s Potential

While I am not a heavy user of the medical system, it is clear that having access to this kind of system will have massive benefits for everyone who uses the service. Fastroi are now working to be able to integrate their Real-Time Care™ system into the Kanta system so that both systems can take advantage of a truly connected service that empowers everyone with access to their own data. As more services integrate into it, then it will only become better.

For us at Fastroi, being able to connect to Kanta is a huge priority, not just because in the future it will be mandatory for the Finnish health and social care sectors, but also because it brings us a step closer to having services that are focussed on the patients and service users. Call it ‘patient centric’ or ‘joined up care’ if you will, this is the real result of a clear vision to have a truly digital health and social care system in Finland. The project will take multiple years of development for Fastroi with the first phases being delivered this year. We also believe that it will benefit not only our customers – the service providers, but also their customers and their families.

Why Should I Invest in Care Management Software

Why Should I Invest in Care Management Software?

Any time you are thinking of investing in new tools for your business it is best to start with asking yourself what you want the software to do for you?  Working out what you want to achieve with the investment is a key question that needs answering. There are many factors that could affect your decision, from inspection ratings, GDPR readiness to improving staff retention and morale. The strongest driver needs to be the desire to improve the quality of care within the organisation. So the software needs to be able to achieve many different things at the same time.

What Do You Need from the Software?

Understanding the drivers is probably the best place to start. In other words, what parts of your business do you need to improve? This is not about putting together a feature list or a set of functional descriptions, more like a high level set of areas that need to be improved. For example:

  • Improving operational efficiency
  • Better care environment
  • Improve regulatory compliance
  • Better performance at inspections
  • Better information storage
  • Reduce staff turnover

Once the drivers have been identified, the task of identifying the features that will help you to achieve the drivers that you have just identified.

Get Creative!

Many vendors will have the basic functionality such as scheduling, rosters, staff & client management or invoicing or payroll. This will be a good starting point to start looking at what else is available. At this point it might be worth getting creative and asking yourselves the question – Wouldn’t it be great if we could……..? This gives you a great opportunity to do two things. The first is to start a relationship with your eventual software provider. If they are serious about what they do, they will be very keen to work with you and to develop their products to suit your requirements. The best ideas often come from the people working at the coal face. The second opportunity is to look at your own business and look for the areas that need improving. By bringing the staff together to look for new software to help manage the business, you can engage the staff and get a good picture of where the software can help improve things for everyone. This will also have the effect of getting buy in from the organisation which will be very important when it comes to implementing the new product. Change is always easier to implement if it is driven by the whole organisation not just the management or IT department.

Juggling the Benefits

By moving from a paper based management system to a digital care management system, we would expect to see significant improvements in the business. The interesting aspect is how broad the range of improvements can be. Some of them will have clear financial benefits, while others will improve the overall quality of care being provided. One of the key advantages is the possibility to measure the improvements. By having a single digital record every action can be recorded. Every task can be marked as done and every report filed quickly and easily. As a result, every driver that was identified as needing to be improved can be measured. By measuring , then it can be improved. This goes for CQC inspections, better financial performance, greater efficiency leads to greater scalability of the business with increased quality or simply reducing medicinal errors. It all adds to a better care environment.

This post isn’t aimed at highlighting one particular vendor over another or one feature over another, but rather to highlight how important it is to look at your own business as a whole when trying to decide on the best care management software for you. A comprehensive system should be able to give you benefits across the whole of your business which is why it  is important to understand where you are and what needs improving. Less functional software may need to be replaced early while many vendors may not have that much experience to fall back on when bringing their new products to the market. Do your homework, ask questions and above all, understand what your really need.